Local Community-based Organizations Research Articles

Experiences and Perceptions of Social Connection Among Minoritized Older Adults With HIV During the COVID-19 Pandemic.

Older people with HIV (OPWH; aged ≥50 years) have unique vulnerabilities to intersecting risks for marginalization and isolation. The current qualitative study explored perceptions of social connection during the coronavirus disease 2019 (COVID-19) pandemic. Purposive sampling was used to recruit participants from two local community-based organizations (CBOs) in the Greater Boston area. Recruitment occurred through dissemination of flyers by staff of the CBOs. Semi-structured interviews were conducted between October 2021 and March 2022. Data were analyzed using thematic analysis. Of 22 participants, most were women (63.6%) and Hispanic/Latinx or African American/Black (86.4%). Participants viewed social connection as an important aspect of well-being, but acknowledged that COVID-19 induced social isolation. There were gender differences in social connection. Technology was adopted by all participants that allowed connection to others. Pre-existing relationships with support groups and CBOs facilitated improved social connection and well-being. Focused attention should be on individuals not linked to CBOs or social services and those who lack access or have barriers to technology use, as they may be at the most significant risk for isolation. [Journal of Gerontological Nursing, xx(xx), xx-xx.].

Public participation and NGO activity in nature-based solutions in urban areas of China

This paper analyses the degree and types of public participation in Nature-Based Solutions (NBS) projects in China. The paper is based upon the premise that NBS affect multiple aspects of the city as a place for the daily lives and activities of citizens and that NBS implementation can benefit from citizen and stakeholder involvement. NBS thus offer a platform for stimulating engagement between the local government and the public. Case studies are examined through a literature review, site visits, and interviews with researchers, local officials and NGOs in China. The paper indicates that there has been significant progress since the 1990s in formal requirements of public participation through Chinese legislation promoting the inclusiveness of the public in environmental and NBS decision-making, and acknowledgment of the importance of NGOs, however actual implementation of soliciting public opinion and involvement in NBS project design has been more limited. The case studies suggest that the level of involvement of the public in NBS activities and decision-making is the reciprocal of the size of the project, where there is a high-level of involvement in the smaller local projects, but minimal involvement in larger-scale NBS projects. We find that Public Private Partnerships (PPPs) have a significant potential to help finance NBS projects providing the project can forecast low risk and positive revenue for investors, therefore this model would merit further exploration. However, PPPs may also involve limited public participation by citizens and stakeholders beyond private companies and may therefore require targeted efforts to address local communities’ needs and interests. Local people are the most important (and willing) actors and opinionators in projects that directly affect their lives, livelihoods and well-being. The findings highlight the important role of NGOs in promoting and facilitating public participation, and accompanying co-benefits, in several of the Chinese case studies. Our study also suggests that symbiosis between local governments and the citizens could be invoked by local community-based organisations (e.g. Community Resident Committees or similar) that can act as a liaison point and catalyst to public participation in NBS projects, although significant training would also be required.

Developing Infectious Disease Outbreak Emergency Communications for Populations With Limited English Proficiency: Insights to Sustain Collaborations Between Local Health Departments and Community-Based Organizations.

State and local public health departments (LHDs) are encouraged to collaborate with community-based organizations (CBOs) to enhance communication and promote protective practices with communities made vulnerable during emergencies, but there is little evidence-based understanding of practical approaches to fostering collaboration in this context. This research focuses on how collaboration enhances LHD capacity for effective communication for people with limited English proficiency (LEP) during infectious disease outbreaks specifically and strategies to facilitate productive LHD-CBO collaboration. Qualitative, telephone interviews, conducted March-October 2021. Rural and urban jurisdictions with Chinese-speaking or Spanish-speaking populations across the United States. 36 LHD and 31 CBO staff working on outreach to Chinese and Spanish speakers during COVID-19. Interviews were audio-recorded, transcribed verbatim, and analyzed using a team-based, codebook approach to thematic analysis. During COVID-19, CBOs extended LHD capacity to develop and disseminate effective communication, meaning communication that is rapidly in-language, culturally resonant, locally relevant, and trusted. Practical strategies to enable and sustain effective collaboration were needed to address operational dimensions (eg, material and administrative) and relational dimensions (eg, promoting trust and respect). Policies and financing to support LHD-CBO collaborations are critical to improving communication with people with LEP and addressing long-standing inequities in outcomes during outbreaks.

Enhancing cultural humility in food is medicine services: A mixed-methods investigation of patient food and dietary preferences

Dietary inequities, influenced by sociocultural and economic factors, significantly affect health outcomes, particularly among underserved communities. To address these disparities, the Food is Medicine (FIM) movement strives to enhance access to nutritious food, provide education, and encourage behavioral changes. Boston Medical Center (BMC) ‘s Nourishing Our Community Program (NOCP) exemplifies this mission by offering FIM services such as an on-site food pantry, rooftop farm, and teaching kitchen. However, persistent barriers hinder the effectiveness of programs like NOCP. This quality improvement (QI) project employed mixed methods to refine existing and develop new patient-generated nutrition education materials and resources across various FIM services. MethodsThis QI project included surveys and focus groups conducted electronically and in person between January and May 2023. We analyzed the data using descriptive statistics and qualitative content analysis. ResultsThe analysis of results revealed patient preferences and experiences regarding dietary patterns, food choices, and nutrition education. These findings enhanced existing handouts, websites, and group class curricula and forged new partnerships with local community-based organizations. ConclusionOur findings underpin the importance of co-designing interventions, dynamic and multimodal resources, and cultural humility in care to meet individual needs. ImplicationsThis initiative is a model for hospitals aiming to improve educational resources within FIM services and tailor content to the specific needs of diverse patient populations. This project is the first step in programmatic improvement, and continuous refinement is crucial for sustained improvements and advancing health equity at our institution.

Challenges and Opportunities for Participatory Evaluation of Local Public Health Efforts to Address Structural Racism and Advance Health Equity

This report describes the process of conducting a participatory evaluation of a local public health department and community partners’ joint efforts to address structural racism and advance health equity in Chicago, Illinois. The participatory evaluation is guided by a multi-partner advisory group composed of academic researchers and research assistants at a local public university; leadership and frontline staff at the local public health department; and individuals employed through local community-based organizations. This report details three key action points in the participatory evaluation process, highlighting the challenges and opportunities that arise while evaluating health equity interventions aimed at institutional and structural change. Insights gleaned from this process can inform ongoing and future participatory evaluation efforts and contribute to the establishment of best practices for partnering across institutions to reshape systems and power relationships to advance health equity.

Roles and Responsibilities of the Organizations Welcoming Immigrants in Remote Regions of Québec

In 1992, Québec’s government adopted a regionalization policy with the intention of enlarging the settlement possibilities for recent immigrants, thus delegating the responsibility of integrating immigrants to the regions’ local community-based organizations. These immigrants arrive in their host society needing information and services concerning their host community. Considering the supporting relationships that community-based organizations in Remote Regions cultivate with immigrants, it is relevant to address the work accomplished by those organizations’ employees. With the aim of better understanding their work, this article examines the community-based organizations responsible for the welcoming and facilitating integration of immigrants. This article proposes an ethnography based on a five blocks model of the regionalization work to take a deeper look at their daily work and gain a better understanding of their specific role in the regionalization of immigration in their community, thereby refining the initial model. It then offers a reflection on the multidimensionality of their work, which goes far beyond employability, and on the specificity of immigration in the context of remote regions.

A Call to Action: Supporting Black Maternal and Infant Health Using the Collective Impact Model.

This commentary advocates for a comprehensive approach to addressing the Black maternal and infant health crisis, utilizing the collective impact model with health equity at its center. Black women in the United States face alarmingly high rates of maternal morbidity and mortality compared to white women. Black women are twice as likely to have premature and low birthweight babies than white women, exposing both the expectant woman and child to various health risks. This crisis stems from systemic racism, implicit bias in healthcare, and a lack of targeted health communications for pregnant Black women. The urgency of this situation requires a bold and unified response through collaboration and coordination among healthcare providers, local and grassroots community-based organizations (CBOs), and digital health communicators. A comprehensive Black maternal and infant health campaign embedded within the collective impact model and led by a dedicated backbone organization would facilitate the coordination and involvement of diverse stakeholders. Central to these efforts should be the acknowledgment that systemic racism perpetuates health inequities. Consequently, any initiatives to improve health outcomes should prioritize health equity by valuing and incorporating Black women's perspectives. This involves crafting a responsive strategy and placing Black women at the forefront of content creation, program strategy, and evaluation. Through a collaborative effort involving healthcare partners, CBOs, and health communicators, we can have an impact far more significant than any single initiative. Immediate action is needed to dismantle systemic barriers and ensure every Black woman and infant receives the care and support they deserve. Black maternal health disparities in the United States have been widely acknowledged and studied. It is well-established that Black women face significantly higher rates of maternal morbidity and mortality compared to their white counterparts, indicative of a severe healthcare crisis. This opinion piece contributes to the discourse by proposing a comprehensive solution grounded in the collective impact model, which emphasizes collaboration and coordination across various stakeholders. This approach represents a shift from past siloed efforts, aiming to tackle the urgent issue of Black maternal and infant health with a multidisciplinary approach centered on health equity.

Farmworker Mobility and COVID-19 Vaccination Strategies: Yuma County, Arizona, 2021.

Farmworkers, a group of essential workers, experience a disproportionately high burden of COVID-19 due to their living and working conditions. This project characterized farmworker mobility in and around Yuma County, Arizona, to identify opportunities to improve farmworker access to COVID-19 vaccination. We collected qualitative and geospatial data through a series of in-person and virtual focus group discussions, key informant interviews, and intercept interviews with participatory mapping. Participants included farmworkers, employers, and representatives of local institutions who serve or interact with farmworkers. We identified participants through purposive and referential sampling and grouped people by sociodemographic characteristics for interviews. We used qualitative and geospatial analyses to identify common themes and mobility patterns. The team interviewed 136 people from February 26 to April 2, 2021. Common themes emerged about how farmworkers have little or no access to COVID-19 vaccination unless offered at their workplaces or at locations where they congregate at convenient times. Further, farmworkers described how their demanding work schedules, long commute times, and caretaker commitments make it challenging to access vaccination services. Geospatial analyses identified three geographic areas in Yuma County where farmworkers reported living and working that did not have a COVID-19 vaccine clinic within walking distance. Coordination between local public health authorities and key partners, including employers and trusted representatives from local community-based organizations or the Mexican consulate, to offer vaccination at worksites or other locations where farmworkers congregate can help improve access to COVID-19 vaccines and booster doses for this population.

Exploring caregiver perspectives in the context of parental substance use: A qualitative study

BackgroundParental substance use is a substantial public health and safeguarding concern. Research examining the impact of parental substance use upon children is well-established, but there is a lack of research examining how parents/caregivers cope with their parenting role within the context of another parent's substance use, or how best to support these parents/caregivers. ObjectiveThis paper examines the experiences and support needs of parents/caregivers impacted by another parent's substance use. ParticipantsNineteen parents/caregivers from substance exposed families via local community-based voluntary sector support organizations, in urban and rural settings in northeast England. MethodsQualitative, in-depth interviews with caregivers (mothers, fathers, grandparents, aunts, uncles, siblings, aged 25 to 65+ years) of dependent aged children (aged 4 to17 years) in substance exposed families. Thematic analysis explored their experiences and support needs. ResultsCumulative stress impacted parents/caregivers in their parenting role, creating further challenges in caring for children impacted by another parent's substance use. Parents/caregivers felt their needs went unrecognized by support services, and interactions with statutory services frequently exacerbated their stress. Parents/caregivers worried about what to disclose to children about substance use and how and when to do this. ConclusionParents/caregivers attempted to mitigate the risk of another parent's substance use upon the children in their care. They often perceived lack of appropriate support specifically for parents/caregivers, particularly considering the extra challenges they faced caring for children in the context of parental substance use. Resources to support parents/caregivers in talking with children about these issues may offer guidance and reassurance to caregivers to alleviate some of their stress.

Community Radio and the promotion of gender equality. A case study of Nyabihoko Sub-County, Ntungamo District

One of the primary roles played by media within communities is fostering unity among people and society as a whole. Community radio serves as a crucial tool in achieving this objective. It is widely acknowledged that community media can encompass various aspects, such as shared interests, locality, and cultural identity. This study focuses on the intersection of community radio and women's empowerment, examining how community media uniquely challenges discriminatory traditions and empowers women. Drawing on multiple development paradigms and feminist theories, the research investigates the extent to which community radio stations contribute to promoting gender equality. The study employs a case study approach in Nyabihoko sub-county, Ntungamo district, Uganda. Utilizing a mixed-methods design, data was gathered from various stakeholders, including clan elders, religious leaders, local council representatives, community-based organizations, and youth, through surveys and qualitative interviews. The research revealed that community radio plays a significant role in enhancing women's empowerment, serving as a vital catalyst for positive change. The findings demonstrate that community radio support significantly contributes to bolstering women's empowerment. After analyzing the collected data, including mean and standard deviation calculations, it became evident that there exists a notable relationship between women's empowerment and gender equality. These findings shed light on the strategies and mechanisms employed by community radio to address gender disparities within the local context. They offer valuable insights for policymakers, media practitioners, and development institutions seeking to leverage the potential of community media for social transformation and empowerment. Keywords: Women empowerment, Radio, Media, Gender equality

A Co-Created Tool to Help Counter Health Misinformation for Spanish-Speaking Communities in the San Francisco Bay Area.

Health misinformation, which was particularly prevalent during the COVID-19 pandemic, hampers public health initiatives. Spanish-speaking communities in the San Francisco Bay Area may be especially affected due to low digital health literacy and skepticism towards science and healthcare experts. Our study aims to develop a checklist to counter misinformation, grounded in community insights. We adopted a multistage approach to understanding barriers to COVID-19 vaccine uptake in Spanish-speaking populations in Alameda and San Francisco counties. Initial work included key informant and community interviews. Partnering with a community-based organization (CBO), we organized co-design workshops in July 2022 to develop a practical tool for identifying misinformation. Template analysis identified key themes for actionable steps, such as source evaluation and content assessment. From this, we developed a Spanish-language checklist. During formative interviews, misinformation was identified as a major obstacle to vaccine uptake. Three co-design workshops with 15 Spanish-speaking women resulted in a 10-step checklist for tackling health misinformation. Participants highlighted the need for scrutinizing sources and assessing messenger credibility, and cues in visual content that could instill fear. The checklist offers a pragmatic approach to source verification and information assessment, supplemented by resources from local CBOs. We have co-created a targeted checklist for Spanish-speaking communities to identify and counter health misinformation. Such specialized tools are essential for populations that are more susceptible to misinformation, enabling them to differentiate between credible and non-credible information.

Critical factors for effective resident participation in neighborhood rehabilitation in Wuhan, China: From the perspectives of diverse stakeholders

Resident participation is essential for neighborhood rehabilitation. It requires the active involvement of residents and efficient management by organizers. To improve the effectiveness of resident participation, it is necessary to understand the critical success factors (CSFs) underlying it. However, previous research has examined the critical factors from a single-stakeholder perspective, overlooking potential differences in perceptions among stakeholders with diverse roles and rehabilitation experiences. Based on 30 interviews and 255 questionnaires from six stakeholder groups in Wuhan, China, this study explores how the perception of critical factors for effective resident participation varies among local government, community-based organization, designer, contractor, consulting party, and resident. Thirty-seven factors were identified and compared among the stakeholders. Financial Incentive (for participation organizers) was identified as the most critical factor for effective resident participation, followed by Information Disclosure and Transparency, and Trust. Results from the analysis of variance (ANOVA) show that the six groups differed significantly in the importance of most factors (25/37), especially in Participant Education and Prejudice against the Working Group. Interview results indicate that the COVID-19 pandemic and rehabilitation experience changed stakeholders’ perceived importance of some factors. Specifically, in future RP initiatives, extra emphasis could be placed on Trait and Capacity (of the working group) and Participation-assistance Technologies. Stakeholders regarded these two factors as more critical as their rehabilitation experience accumulated. By understanding stakeholders' conflicting and changing perceptions of effective resident participation, suggestions were proposed to each stakeholder group to fulfill their distinct participation objectives and improve the overall effectiveness of participation practices.

THE AGING NETWORK AS A CATALYST FOR COMMUNITY GERONTOLOGY AND APPLIED RESEARCH

Abstract The Older Americans Act (OAA) established Area Agencies on Aging (AAAs) fifty years ago as local community-based organizations responsible for planning, coordinating, funding, and delivering nutrition and other supportive services which allow older adults to remain living in their homes and communities. Local control and decision-making, mandated by the OAA, has allowed AAAs to adapt to the evolving needs and demands of their communities The centrality of their role was never more apparent than during the COVID-19 pandemic. As national and societal circumstances have resulted in increased social isolation, housing insecurity, and public health concerns for older adults, AAAs have adapted and expanded beyond traditional OAA services to address the social and health needs of an increasingly diverse older adult population. The Community Gerontology framework provides a useful structure to understand the evolution and impact of AAAs and the broader Aging Network on the health of older adults. Using data from the 2022 National Survey of AAAs and a new qualitative study on Community Care Hubs, academic and Aging Network-based researchers will illustrate the many partnerships and pathways of mutual influence between AAAs and the micro and macro levels to describe how Aging Network services are expanding provision of services for health care partners, public health initiatives, and new housing and homelessness services and partnerships to address emerging needs. The symposium will conclude with an illustration of how applied researchers and Aging Network organizations partnered on research-informed practice to innovate and strengthen services for at-risk older adults.

Influences on decision-making about disclosure of HIV status by adolescents and young adults living with HIV in KwaZulu-Natal, South Africa

Background: Adolescents and young adults living with HIV (AYA) are faced with the challenge of living with a life-long chronic condition. We investigated the influences on the decisions by AYA to disclose their HIV status to family, intimate partners and friends. Methods: Twenty AYA aged between 15 and 24 years were purposely selected through local community-based organisations in eThekwini municipality and uMkhanyakude district in KwaZulu-Natal Province, South Africa. Virtual in-depth interviews were conducted between September 2020 to October 2021 using a topic guide focusing on HIV-status disclosure and the impact of stigma on decision-making capacity. An iterative thematic process was used for analysis. Results: Findings revealed the challenges that AYA experience for disclosure because of stigma and how this impacts their decision-making capacity. Family and friends influenced AYA in processing their discovery of their HIV status offering support needed to manage living with HIV. However, for some AYA disclosing to relatives, friends and intimate partners was difficult because of fears of rejection and recrimination. The act of disclosure was influenced by both internalised and external stigma and the type of relationships and interactions that AYA had with relatives, friends and caregivers. Conclusions: The decision to disclose is challenging for AYA because of the fear of rejection, along with internal and external stigma. The provision of support, whether from family or peers, is important. Enhancing the decision-making capacity of AYA is essential for developing their self-esteem as well as supporting future healthcare choices.

Attitudes toward dementia and cognitive aging among Syrian refugees resettled in Jordan: a qualitative study

BackgroundMounting evidence is revealing disparities in cognitive function and heightened dementia risk among refugees, yet research in this area remains scant. Despite bearing most of the world’s refugee burden, limited-resource countries like Jordan are facing challenges when dealing with refugee health. There is a lack of research on the attitudes toward dementia and the cognitive healthcare gaps among refugees in Jordan.Methods32 older (≥ 55 years) Syrian refugees resettled in Jordan were recruited through a local community-based organization and interviewed in four focus groups (2 female and 2 male groups). Interviews were transcribed and translated, then coded using inductive thematic analysis.ResultsMean age of the sample was 60.1 years and 53.1% were female. Only 34.4% rated their memory as good or excellent. Themes were organized using the socioecological model: 1) At the individual level, participants believed high levels of stress, including low socioeconomic status, poor health, and traumatic history from their refugee experience increased their dementia risk. 2) Interpersonally, there is a fear of dementia due to the possible impact and burden on loved ones, particularly with the stigma surrounding dementia. 3) At the community level, participants noted that resettlement in Jordan – with a shared language, religion, and culture – offered protective effects due to facilitated access to social connection, information, and mental health self-care. 4) At the institution and policy level, participants believed older refugees faced restrictive policies for economic aid, healthcare, and employment, presenting a significant barrier to healthy aging.ConclusionsFindings from this study are the first to examine the attitudes of Syrian refugees in Jordan toward dementia and cognitive aging. These results could provide essential data inclusive of refugees as Jordan develops its National Dementia Plan. Investing in dementia awareness interventions and age-friendly neighborhoods may benefit aging refugees in limited-resources settings.

Lights, Facts, and Goals: A Novel Framework to Enhance Community Health Messaging Campaign Design, Implementation, and Assessment.

The spread of health misinformation has made the task of health communicators more difficult. However, the success of health messaging hinges not only on meaningful message content but also on the credibility of who is delivering the message. "Trusted messengers," like local leaders and community-based organizations, have a greater ability to influence improvements in community health, due to their shared cultural experience with their communities. Health communication agencies should empower trusted messengers with the tools they need to succeed in health communication. One tool critical for their success is a succinct health messaging framework to plan and implement health messaging. Marketing has "See, Think, Do"-a simple, practical framework used to influence consumer purchases. As a more trustworthy corollary, we propose the "Lights, Facts, and Goals" framework, a concise, authentic, and transparent method for planning, implementing, and assessing health messaging campaigns that influence health improvements. "Lights" refers to different methods of reaching communities like trusted messengers, advertisements, and text messages. "Facts" refers to key sourced scientific information relevant to a specific aspect of community health. "Goals" refers to actions community members can take to improve their health in connection with the communicated health facts. This article describes how the "Lights, Facts, and Goals" framework both simplifies the creation and communication of scientifically sound health messaging and strengthens the partnership between health agencies and trusted messengers in the community. Through "Lights, Facts, and Goals," community-based organizations, community leaders, and their partners will be more effective at improving community health through messaging.

Quality of Care Among Emerging Adults with Sickle Cell Disease Using the Ascq-ME Qoc Measure: Baseline ST3P-up Study Data Results

ASCQ-Me ® ( Adult Sickle Cell Quality of Life Measurement Information System) is a disease specific patient-reported outcome measurement system to evaluate and track the physical, mental, and social well-being of adults living with sickle cell disease (SCD). It includes a mixed format ASCQ-Me Quality of Care (QOC) measure which aims to quantitatively, and qualitatively, understand the way adults living with SCD experience healthcare. The ASCQ-Me QOC measure follows the Donabedian's model that evaluates health services research around structure, process, and outcomes of healthcare system interactions.1 Prior and ongoing research report that adults with SCD avoid going to the emergency department (ED) for acute symptoms.2,3 Poor provider knowledge and understanding of SCD feeds a misperception as drug seeking and heightens the structural inequities and racial stigma of living with the disease.4 This is further compounded by poor adherence to acute triage guidelines, disbelief in patient reports of pain and of their usual care plan, severe delays in receiving acute care, poor provider patient communication and distrust. The Sickle Cell Trevor Thompson Transition Project (ST3P-UP), a multicenter, comparative effectiveness study of a structured education-based transition program +/- peer mentoring to improve acute care utilization for SCD ages 16-26y was conducted at 14 SCD clinical sites.5 Each site was required to engage a community-based organization (CBO) and had established community advisory boards (CABs) focused on collaborative partnerships to improve access to and experience of care. The study captured baseline and longitudinal reports of patients' experiences with health care using the ASCQ-Me QOC measure on all enrolled participants with annual rescoring as part of routine care. ST3P-UP study demographics: N=291, mean age 18.8y (SD1.5); 52% F; 96% Black; 3.6 acute care visits/yr. at baseline (range 0-31, SD4.9). Over 84% of participants reported being usually or always satisfied with the QOC when care was needed right away. Overall health care was rated between 7-10 (10 = best care possible) by 83%; 73% reported they usually or always were able to access care right away when needed while 78% usually or always waited <2h to receive treatment for their acute pain. These reports were equivalent to that reported when SCD experts care for SCD patients. QOC scores for ED care were higher than previously published and also better than anecdotal reports. Specifically, patients reported that they felt the doctors (84% of the time) and nurses (83% of the time) usually or always seemed to really care about them and that when they needed care right away, they were treated with courtesy and respect by clerks and receptionists usually or always 87% of the time. Only 11% of participants reported that providers were able to only help their pain “a little or not at all” and that providers “ did not” or “only slightly” believed their report of pain, respectively. Participants were usually or always satisfied with the care received in the ED 94.1% of the time. However, a bad experience continues to drive the decision to avoid going to the ED for care in 63% of participants. A previous report by Kanter et al cited only 51% of adults with SCD were usually or always satisfied with the ED care received and 52% indicated a bad experience in the ED led them to decide to avoid seeking care.6 These results demonstrate a surprisingly higher satisfaction with the quality, process and outcomes of ED care delivered and less discrepancy between ambulatory vs. ED care than expected compared to published and anecdotal reports. This could reflect the bias of ST3P-UP study enrollment and a younger patient population with ~25% having <1 baseline acute visits /yr. ST3P-UP sites had existing strong partnerships with providers, a local CBO and established CABs thus care may not be generalizable to the broader SCD care ecosystem. While longitudinal survey results will be important as comparison, our data highlights the value of objectively quantifying ambulatory and ED experiences soon after a visit to gain quantitative insights into these experiences. Our results do not obviate the need for subjective reports on specific experiences however both types of data can guide local and systemic improvement efforts with attention on identifying subpopulations differently affected and interventions that lower the risk for poor QOC experiences.

Community and local partner: ‘Must-to-Have’ elements for achieving immunization target in Somalia

Abstract We have been working on a community-based project aiming to improve access to quality Immunization by strengthening the capacity of health structures and communities with identified immunization gaps in the Galgaduud and Jubaland states in Somalia. The project is delivered in partnership with Ministry of Health, UNICEF (strategic partner), Acasus (for data management using digital platform), and two local implementing organization WASDA and WRRS as local implementing agencies. Owing to the varying levels of insecurity in the regions targeted, to deliver to ensure optimal immunization services to communities without delay, we operationalized a rapid and intensive scale-up of immunization services in 27 health facilities and sites following a phased approach. The project also supported the set-up and strengthening of community-driven immunization systems as well as district-level immunization management systems to promote ownership of the immunization programs within the target locations. To achieve this the project is anchored on four pillars namely capacity strengthening (at community, facility, and district/regional level), immunization logistics and supply chain strengthening, use of data for decision making and scaling-up innovative approaches. The project efforts achieved most of its targets throughout the implementation period, more so in the second and third year. Between April 2021 and February 2022, supportive supervision was increased from 54% to 100% of facilities and the average number of monthly fixed and outreach immunization sessions increased by 54% and 31%, respectively. We found the number of Penta3 doses delivered was more than double while we compared data for 2021 and 2022. These encouraging results suggest critical importance of local community engagement in planning and monitoring plus having local community-based organizations for implementing the project in similar remote rural areas with high security risks in Somalia. Key messages • Without having intensive community engagement efforts, immunization project implementation in high security risk areas in Somalia is almost impossible. • Local community-based organizations as implementing partner is the other critical mass for success in achieving immunization target in similar high security risk areas like Somalia.

If you build it, they may not come: Understanding factors influencing use of a community resource referral technology.

Identify factors affecting the use of a community resource referral platform among local community-based organizations (CBOs) and test strategies to increase platform use. Data sources included platform usage data and semi-structured interviews. The study took place in a small city in the Northeastern United States from 2020 to 2022. We analyzed platform data and conducted interviews with local organizations and organizations in other communities to understand barriers to CBOs' use of the referral platform and identify strategies that might increase use. We then tested 4 strategies and assessed impacts via time trend analysis of platform usage and qualitative interviews. Platform usage data were obtained from the platform. Semi-structured interviews were conducted with staff and leaders of 36 local CBOs and 9 external organizations. Four years after launch, platform use remained relatively low. None of the tested strategies (data insight reports, a referral hub, tailored training, and a communication campaign) noticeably increased platform use. The main barrier to the use of the platform was the lack of perceived usefulness, mostly because existing processes for identifying resources and referring clients worked well enough and because many organizations were already required to use a client management or referral tool. Additional barriers included the lack of comfort with and, in some cases, active dislike of e-referrals, and lack of comfort with technology tools overall. Organizations that were most likely to find the platform useful and to use it were those that provided referrals for a wide range of needs and whose staff were not already familiar with local resources. Organizations seeking to implement referral platforms should not assume that local CBOs will automatically take up these platforms. For these platforms to succeed, much more attention needs to be paid to ensuring the platforms provide value to the CBOs they seek to engage.

Analysis of the solidarity economy in rural tourism

This article analyzes the development of rural community-based tourism from a case study in the municipality of Sibaté in the department of Cundinamarca, Colombia. The objective of this article is to identify the success factors that determine tourism development in the rural territory, its relationship with the communities and territorial appropriation. The methodological horizon was structured from a mixed approach and the case study was used as a method; in-depth interviews were conducted and the analysis process was supported by the grounded theory of the data. The results show that the determining factors in the development of tourism are community empowerment, recognition of the symbolic value of local resources and community-based organization. It is concluded that the "Sibatenado" tourism initiative succeeded in activating the multifunctionality of the rural territory, overcoming the traditional productive vision and potentiating the possibilities of revaluing the rural territory.