Local Community Center Research Articles

A lifestyle program for socially vulnerable community-dwelling elderly

Abstract Problem Socially vulnerable older adults often face lower health literacy and limited access to health care. Description of the problem Current lifestyle programs are often insufficiently adapted to this socially vulnerable target group. As a result, these older adults are underrepresented in lifestyle programs. From a public health perspective, lifestyle programs that improve the poorer physical and mental health of these older adults, should be made more accessible by involving the expertise, participation and needs of this group. The aim of this study was to develop and implement a lifestyle program adapted to the expectations and needs of socially vulnerable older adults. Results Both the target group and the local community (health) centers were involved during the co-creative phase of development. A neighborhood analysis was used to identify and reach out to the target group. Motivators and barriers for a healthy lifestyle were identified through focus groups. The developed program consisted of 10 weekly group sessions. Various health aspects were integrated, including exercise, nutrition, stress, sleep, positive psychology, meaningful living, and motivation. Nine centers for community dwelling older adults in Flanders and Brussels were included. In total, 93 older adults were recruited out of which 76 completed the full program. In the final phase, the program was evaluated by means of objective and subjective measuring methods. Finally, the local community (health) centers are currently involved in the program’s sustainability through a trainers’ program. Lessons The belongingness, the catering, the empowering attitude of the trainer and the ‘fun’ factor turned out to be success factors for the adherence to the program. The participating centres experienced an increase in numbers of older adults that were attracted to their activities that are focused on healthy lifestyle behaviors. The continuity of the program is currently being examined. Key messages • A neighbourhood analysis in collaboration with local partners helped to reach the target group. • The program was made attractive by the involvement of the older adults, the fun-factor and the small groups.

New Brunswick HEARS: outcomes of a community-delivered hearing intervention adapted for older adults in Atlantic Canada

Objective To assess acceptability and benefit of a community-based hearing intervention delivered at no cost to lower-income older adults with untreated hearing loss in New Brunswick, Canada. Design Mixed method pre-post intervention study investigating aspects of communication function and social support at baseline and three months post-intervention. Study Sample 124 of 175 independent-living older adults screened at the study site and in local community centres in low-income neighbourhoods were recruited into the study. Results In 70 (56.5%) participants self-identified as female and 54 (43.5%) as male, with mean age of 74.5 years, mean effect sizes measured from baseline to 3-months post-intervention were 0.99 (large) for HHIE-S, 0.58 (medium) for DSSI, and 1.02 (large) for LSEQ indicating significant improvement in self-perceived communication function, social support and listening self-efficacy, respectively. Conclusion The HEARS program is feasible to implement, despite Covid-19 pandemic related challenges, highly acceptable to participants, and associated with a range of benefits that include improved communication function, self-efficacy and social support. The success of HEARS in a new population in a second Canadian province indicates its adaptability and suitability for scaling to extend the reach of hearing services for older adults who may not otherwise access care.

Exploring everyday racist symbolism in community recreation spaces: a critical race content analysis

ABSTRACT There has been a palpable shift in the public’s collective consciousness about the realities of racism in recent years. Community recreation organizations, like all other institutions, are not exempt from promoting racial inequity through taken for granted policies and practices. The purpose of this study was to explore some of the racist symbolism found within everyday artifacts at local community centres in a sub-urban area of Ontario, Canada. A Critical Race Content Analysis methodology was used to analyze bandages, promotional materials, and sunscreen. This study found that bandages in first aid supplies were exclusively for White skin tones, images in promotional materials featured mostly White people, and the sunscreen products stocked were not made for dark skinned folx. A discussion on the implications of each finding is provided followed by limitations and recommendations for research and practice.

Abstract B046: Factors influencing patient decision-making to complete Low Dose CT screening for lung cancer

Abstract As part of a randomized, controlled trial (RCT) to increase lung cancer screening (LCS) with low-dose CT scan (LDCT) within the Choctaw Nation of Oklahoma’s tribal health system, we conducted a qualitative study to explore the barriers behind patient decisions to forego screening. Thirty eligible participants who had been in the RCT for at least one year were identified as LCS completers (n=7) or non-completers (n=23). A single interviewer completed all interviews using a semi-structured interview guide, designed to explore experiences, barriers/facilitators to LCS, factors influencing screening decisions, and suggested strategies for expanding the LCS program into the community. Interviews were recorded and transcribed verbatim. Data were analyzed using conventional content analysis. Most non-completers reported having no conversations about the availability of LCS with their primary care provider (PCP) or receiving any information about the LCS program. In contrast, the completers all reported PCP-initiated discussions about the LCS program, their risk factors, and an overview of the testing process. Key themes that emerged included fears, e.g., being unsure about what the test involves, afraid of being diagnosed with lung cancer and what might follow, and afraid of dying. Some voiced concerns, e.g., feeling guilty as active smokers and being stigmatized should they be diagnosed with lung cancer. Many participants posited that there was no reason for screening without symptoms. Lack of understanding, especially about cancer care, was identified as a contributing factor. Suggested strategies to increase the reach into the community included using existing infrastructure within Choctaw Nation, such as disseminating information through the tribal newsletter, inserts in prescription refills, and notifications via the patient portal. Community education programs at local community centers, particularly around senior citizen meals, were offered as strategies to change the perception that lung cancer is a death sentence. Hosting an informational booth at the annual tribal Labor Day festival was commonly suggested. In conclusion, multiple reasons were cited for forgoing LDCT screening. In this tribal setting, findings are similar to ones documented in other settings. This suggests that interventions to overcome these challenges may build off known evidence-based interventions, such as the recommendations for cancer prevention documented by the Community Preventive Services Task Force. Addressing fears through multiple educational approaches and adapting strategies from the American Lung Association to address stigma could lead to enhanced interventions. Finally, capitalizing on tribal resources (newsletter) and tribal events to increase LCS awareness may be promising strategies to improve screening in the local tribal setting. Citation Format: Kathleen Dwyer, Zsolt Nagykaldi, Mark Doescher, Dorothy A. Rhoades. Factors influencing patient decision-making to complete Low Dose CT screening for lung cancer [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 B046.

P157 THE USE OF PARTICIPATORY ACTION RESEARCH TO PROMOTE INCREASED CONSUMPTION OF VEGETABLES AMONG AFRICAN WOMEN WITH/AT RISK OF HYPERTENSION IN GQEBERHA, SOUTH AFRICA

Background and objectives: Poor vegetable and fruit intake are reported in multiple studies of the South African population, especially among people with less income and lower educational status and it is a known risk factor for non-communicable diseases such as hypertension. “South Africa has one of the highest levels of hypertension globally, coupled with poor rates of diagnosis, treatment and control” Ware et al., (2019). It has been suggested that indigenous vegetables may aid in increasing vegetable intake, a recommendation of the South African Food Based Dietary Guidelines. As urbanisation and the nutrition transition increases in South Africa, the loss of indigenous knowledge and utilisation of indigenous vegetables is significant and is worse compared to countries such as Kenya and Tanzania. The aim of this study was to collaboratively promote the use of indigenous vegetables by African women in a peri-urban area with/at risk of hypertension with the goal of improving agency to increase vegetable intake. Methods: A qualitative participatory action research (PAR) methodology was utilised. African adult women with hypertension or at risk of hypertension were recruited from a local healthcare facility for a one year long project, with a total enrolment of 12-24 participants. Data collection included observations, focus groups, key informant interviews and the research journal of the researcher. Results: Participants worked collaboratively to co-construct relevant nutrition education materials, recipe development using local indigenous vegetables, clinic open day and a seminar for other community members. There was greater uptake of vegetable gardening at home and at the local community centre. Conclusions: using PAR methodologies to address inadequate vegetable intake and promote the use of indigenous vegetable crops may benefit personal agency which includes an individual's perceptions about how much control they have over themselves and their environment, in order to carry out a certain behaviour; self-confidence or efficacy; the ability to self-regulate and monitor behaviour and the ability to identify and use good coping skills.

Administrative Analysis of the Home-Based Older Persons Upstreaming Prevention Physical Therapy Program: A Pilot Observational Study.

Introduction Traditionally, physical therapist (PT) services do not commence until an injury, fall, or health issue has already occurred although there is increasing evidence that preventative programs administered by PTs may decrease the fall risk among elderly individuals.The purpose of this study was to examine billing, reimbursement, and administrative outcomes of the previously established and investigated prevention-based screening and intervention HOP-UP-PT (Home-based Older Persons Upstreaming Prevention-Physical Therapy) program delivered by a physical therapist in the home of older adults after being referred by a community partner. A randomized controlled trial of the HOP-UP-PT program demonstrated an 8-fold reduction in falls for participants at moderate and high fall risk compared to those who did not participate in the program. Methods Aprospective observational study was performed to examine administrative and payment outcomes of HOP-UP-PT participation. Participants were referred into the HOP-UP-PT program via a local community center. Physician authorization for physical therapy participation was obtained for each participant as required for payment under United States' Center for Medicare and Medicaid Services (CMS)guidelines. The HOP-UP-PT program is preventative physical therapy delivered in the person's home with five in person visits (approximately one per month) followed by a monthly telehealth visit and a final in-person visit.Interventions included a balance program, home safety recommendations, health coaching, and addressing individual risks of falling or becoming homebound. A retrospective analysis was performed on the administrative andinsurance payment data from this study which was then analyzed descriptively. Results Six participants with four different insurances completed the 7-month program (mean age=77 years) in 2021. The physical therapy visits were submitted to the participants' Medicare Part B plan. One participant's physical therapy visits were not submitted for payment as the health system did not have an active agreement with that health insurer. Due to the unclear status of telehealth visits in 2021, these services were not submitted to the insurance company for payment.All other PT visits were paid by the insurance companies. The mean amount paid for the initial evaluation code was $102.83 and the mean payment for the ~15 minute treatment codes was $25.90 per unit. Initial pilot data demonstrated a potential for a4.2% positive operating margin when considering salary costs and travel.The mean delay from the initial referral into the HOP-UP-PT program until the physician provided written authorization for physical therapy was 69.7 days. Conclusion This study demonstrated initial evidence that payment for prevention-focused outpatient physical therapist services delivered in the home was feasible, however delays and costsin procuring physician authorization was a substantial barrier to prevention-focused physical therapy. A 4.2% operating margin demonstrated that, when efficiently operated, similar programs are likely to be viable. Furthermore, if telehealth services would have been paid, the operating margin was estimated to increase to 32%. Physical therapists are highly qualified to deliver efficient, effective preventative services which has the potential to reduce falls and institutionalization and subsequent healthcare cost savings.

Social Justice in Community Environments: A Collaborative Photovoice Process

A small New England University and a local community center undertook a community based participatory research approach to understand the community-driven factors that most impact health. Photovoice was utilized to collaboratively highlight priority issues and to collectively advocate for change. The Photovoice approach was particularly useful in this context to transcend language differences and foster community dialogue between community and institutional partners in a way that dismantled traditional — and historically harmful — power dynamics between institutions and communities. The goal of utilizing this participatory-based method was to support community-identified social-ecological change, advocate for identified environmental justice priority issues, and support sustained community involvement. The novel aspects of the approach included guiding students and community members through this process in a community-engaged learning context that brought together linguistically diverse populations with a foundation of cultural humility, respect, and multi-directional learning.

Problem-based learning of an intensive design studio block unit in collaboration with a local community centre

Problem-based learning of an intensive design studio block unit in collaboration with a local community centre

Sure as the sunrise: insights into the material culture of Albion Motors from Glasgow Life’s museums and archives collection

ABSTRACT Albion Motors Ltd was a large company based in Scotstoun, Glasgow, employing thousands over its nine-decades existence. Much is known about its manufacturing output of cars, lorries, and buses, so the purpose of this research was to investigate Albion-related archive material held by Glasgow Life and consider this within a social historic context. The paper is replete with evidence of the human experience of the company, obtained through various research methods including scrutiny of primary source material, site visits, and unstructured in-person and telephone interviews. Whilst containing some inconclusive elements, the personal testimony of one former employee, which so effectively brought the past to life, was a poignant reminder to continue this research. Thankfully, the local community centre in Scotstoun had a similar idea, to host an open day for former staff to share memories of working for Albion – proving there are many anecdotes yet to document.

ORAL HEALTH EQUITY, BELIEFS, PRACTICES, PERCEPTIONS AMONG OLDER DETROIT RESIDENTS

Abstract Oral health disparities are widespread among older and disadvantaged Detroit residents. While preventable, poor oral health is strongly associated with adverse health and social outcomes and increased risk of cognitive impairments. To address limitations in access and knowledge among older Detroit persons, the University of Detroit Mercy Oral Health Equity project is providing free drop-in clinics offering screenings and basic care at multiple local community centers. However, we need person-centered knowledge about the reasons for an individual’s current oral health status and to inform strategies to increase service uptake. We conducted interviews with attendees onsite after their services to learn oral health perceptions, wants, and practices. Findings are reported from a sample, n=62, of predominantly African American, median age 81, female 69%, 50% over two years without a dental visit, and 61% fair to poor self-reported oral health. Analyses used topic, theme, pattern, and critical case content analytic methods. Constructs comprising four key domains were identified: (a) Oral health care exists at the intersection of forces featuring societal, political, historical, local urban place, and economic dimensions beyond individual-level health and behaviors; (b) lifespan pathways into current oral health and care practices, including wishes for future oral health status; (c) barriers and resources to oral health care access and practices; and (d) personal knowledge gaps regarding signs and mechanisms of oral health. Discussion will focus on strategies to reduce disparities and increase utilization, community and person-level knowledge gaps, and training dental students to engage older disadvantaged persons effectively.

The association between satisfaction with life and anxiety symptoms among Chinese elderly: a moderated mediation analysis

BackgroundPrevious studies have suggested that certain personal psychological variables (e.g., life satisfaction and cognitive function) and physical variables (e.g., body mass index [BMI]) are significantly associated with individuals’ anxiety symptoms. However, relevant research on elderly is lagging and no studies have yet investigated the combined impact of these variables on anxiety. Thus, we conducted the present study to investigate the potential moderator role of BMI and the potential mediator role of cognitive function underlying the relationship between life satisfaction and anxiety symptoms in Chinese elderly based in Hong Kong.MethodsSixty-seven elderly aged 65 years old and above were recruited from the local elderly community centres in this pilot study. Each participant underwent a systematic evaluation using the Satisfaction with Life Scale (SWLS), Hong Kong Version of the Montreal Cognitive Assessment (HK-MoCA), and the Hamilton Anxiety Rating Scale (HAM-A) and were measured for their body weight and height. Regression analysis using the bootstrapping method was employed to test the hypothesized moderated mediation model.ResultsOur findings demonstrated the overall model accounted for 23.05% of the variance in scores of HAM-A (F (8, 57) = 2.134, p = 0.047) in Chinese elderly. There was a significant association between life satisfaction and anxiety symptoms (p = 0.031), indicating that individuals with higher life satisfaction were associated with less anxiety symptoms. Moreover, this relationship was positively moderated by BMI (b = 0.066, 95% CI [0.004, 0.128]), especially in Chinese elderly with BMI at a lower level (b = -0.571, 95% CI [-0.919, -0.224]) and an average level (b = -0.242, 95% CI [-0.460, -0.023]). No significant mediator role was detected for cognitive function (b = -0.006, 95% CI [-0.047, 0.044]) in our model.ConclusionsOur findings suggest that increased life satisfaction can reduce anxiety symptoms among Chinese elderly as their BMI decreases (when BMI ranged between “mean - 1SD” and “mean” of the population). The significant interaction between psychological and physical factors underlying anxiety symptoms found in this study, presents a promising opportunity for translation into multi-level psychological and physical interventions for the management of anxiety in ageing patients during clinical practice.

Effectiveness of telehealth in preventive care: a study protocol for a randomised controlled trial of tele-exercise programme involving older people with possible sarcopenia or at risk of fall

BackgroundContinuous loss of muscle mass and strength are the consequences of the ageing process, which increase the risk of falls among older people. Falls can lead to severe consequences such as bone fractures and hampered physical and psychological well-being. Regular exercise is the key to reversing muscle atrophy and relieving sarcopenia. However, the frailty of older people and the recent COVID-19 pandemic may affect their confidence to leave home to attend classes in the community. A feasible and effective alternative should be explored.MethodsThe primary objective is to evaluate the effectiveness of tele-exercise (TE) in relation to physical functioning and exercise adherence among community-dwelling older people at risk of falls in comparison with a community-based group (CB). The secondary objective includes evaluating older people’s experience with tele-exercise, emphasizing their psychological welfare, social well-being, and acceptance of the telehealth approach. The design, conduct, and report follow the SPIRIT guidelines (Standard Protocol Items: recommended items to address in a Clinical Trial Protocol and Related Documents). Older people will be recruited from 10 local community centres in Hong Kong and randomly allocated into two groups. All participants will attend the exercise training 3 days per week for 3 months but the mode of delivery will differ, either online as the tele-exercise group (TE) or face-to-face as the community-based group (CB). The outcome measures include muscle strength, physical function, exercise adherence and dropout rate, psychological and social well-being will be assessed at the baseline, and the 3rd, 6th and 12th month. Some participants will be invited to attend focus group interviews to evaluate their overall experience of the tele-exercise training.DiscussionTele-exercise reduces the barriers to exercise, such as time constraints, inaccessibility to facilities, and the fear of frail older people leaving their homes. Promoting an online home-based exercise programme for older people can encourage them to engage in regular physical activity and increase their exercise adherence even when remaining at home. The use of telehealth can potentially result in savings in cost and time. The final findings will provide insights on delivering exercise via telehealth to older people and propose an exercise delivery and maintenance model for future practice.Trial registrationChinese Clinical Trial Registry (https://www.chictr.org.cn/hvshowprojectEN.html?id=219002&v=1.1), registration number: ChiCTR2200063370. Registered on 5 September 2022.

Effects of Sport Participation on Gait Coordination, Symmetry, and Variability in Older Adults.

The aim of this study was to compare the interlimb coordination, asymmetry, and variability between older adults who participated in sports (n = 25; age = 72.6 ± 6.46years) and sedentary older adults (n = 20; age = 70.85 ± 3.82years). The sport participants were selected from tennis and badminton clubs, whereas the sedentary participants were recruited from local community centers. The participants walked at their preferred speed in a 10-m walkway for 2min. The interlimb coordination was measured by the phase coordination index. Other walking metrics were speed, cadence, swing time, stance time, double-support time, stride time, and swing time asymmetry. The results showed that the sport participants relative to the sedentary group had better interlimb coordination, higher walking speed and cadence, and less swing time variability. Young older adults also had a better interlimb coordination. In conclusion, the findings of this study showed that long-term participation in sports has some antiaging benefits on gait coordination and symmetry in older adults.

Abstract 12594: Comparison of Effects of Face-to-Face and Online Community-Based Healthy Lifestyle Behavior Change Programs on Life Simple 7 Score in the Elderly

Introduction: The Life Simple 7 (LS7) score, developed by the American Heart Association, is a powerful predictor of an individual's cardiovascular health. It consists of seven key cardiovascular health metrics, including cholesterol levels, blood pressure, blood sugar, body mass index, diet, smoking status, and physical activity levels. In-person behavior change programs that target LS7 may not be accessible to older people. Aims: Our aim was to compare the impact of face-to-face and online community-based programs on the LS7 score among elderly individuals. Methods: Elderly participants were recruited from local community centers and randomly assigned to either a face-to-face or online program group. The face-to-face group attended weekly sessions at the community center, while the online group received program content through a web-based platform. Changes in the LS7 score were measured at baseline and six weeks after the intervention. An analysis of covariance (ANCOVA) was used to compare outcomes. Results: A total of 114 elderly individuals, with an average age of 71.75 ± 10.39 and 70.8% males, participated in the study (face-to-face group, n=48; online group, N=66. The findings indicate significant improvements in blood pressure (p=0.048), cholesterol (p=0.021), exercise (p=0.000), and diet scores (p=0.001). However, no significant differences were observed between the two groups (F=0.16, p>.05). Conclusion: The findings suggest that both modes of intervention are effective in improving cardiovascular health, highlighting the potential of online programs during times such as the COVID-19 pandemic or in rural areas.

Family-Centered Prevention to Reduce Discrimination-Related Depressive Symptoms Among Black Adolescents

Racial discrimination undermines the mental health of Black adolescents. Preventive interventions that can attenuate the effects of exposure to racial discrimination are needed. To investigate whether participation in the Strong African American Families (SAAF) program moderates Black adolescents' depressive symptoms associated with experience of racial discrimination. This secondary analysis used data from a community-based randomized clinical trial of SAAF (SAAF vs no treatment control). Participants were followed up at 10, 22, and 34 months after the baseline assessment. Assessment staff were blind to participant condition. Participants in this trial lived in 7 rural counties in Georgia. SAAF was delivered at local community centers. Eligible families had a child aged 11 to 12 years who self-identified as African American or Black. The joint influence of random assignment to SAAF and exposure to racial discrimination was investigated. Data were analyzed from September 2022 to March 2023. SAAF is a 7-session (14 hours) family skills training intervention that occurs over 7 weeks. Small groups of caregivers and their adolescents participate in a structured curriculum targeting effective parenting behavior, adolescent self-regulation, and Black pride. The main outcome was adolescent-reported depressive symptoms, assessed at 34 months via the 20-item Center for Epidemiologic Studies Depression Scale for Children. Of 825 families screened randomly from public school lists, 472 adolescents (mean [SD] age, 11.6 years; 240 [50.8%] female) were enrolled and randomized to SAAF (252 participants) or a no treatment control (220 participants). Exposure to racial discrimination at age 13 years was associated with increased depressive symptoms at age 14 years (β = 0.23; 95% CI, 0.13 to 0.34; P < .001). Interaction analyses indicated that the experimental condition significantly moderated the association of racial discrimination with depressive symptoms: (β = -0.27; 95% CI, -0.47 to -0.08; P = .005). Probing the interaction with simple slopes at ±SD revealed that for the control group, racial discrimination was significantly associated with depressive symptoms (β = 0.39; 95% CI, 0.23 to 0.54; P < .001), while for the SAAF group, there was no association between racial discrimination and depressive symptoms (β = 0.12; P = .09). This randomized clinical trial found that the SAAF intervention reduced the incidence of racism-associated mental health symptoms among Black adolescents. SAAF is recommended for dissemination to health care practitioners working with rural Black adolescents. ClinicalTrials.gov Identifier: NCT03590132.

36 Disparities in General Mental Status Between Lower and Higher SES Ethnically Diverse Older Adults

Objective:To investigate differences in performance on a widely used cognitive screener between community-dwelling older adults from two disparate socioeconomic groups.Participants and Methods:Participants were part of a larger study of cognitive screening in healthy older adults. The total sample (N=79, 69.6% female, 19% White/Caucasian, 12.7% Asian, 43% Latino/a, 25.3% Black/African-American) consisted of community-dwelling adults (Mage=73.1 years [SD=7.2] and Meducation=14.3 years [SD=2.6]) who were initially recruited via social media, flyers, and general community announcements. A lack of ethnic minority participants resulted in a two-year commitment to reach communities of color via visits and provision of health literacy to local religious and community programs. Continuous contact with leaders/gatekeepers helped establish research study credibility and forge a stronger sense of trust among ethnically diverse participants in the greater Houston, TX, area. Testing was initially conducted at the clinical study site. Due to low participation rates among people of color, greater effort was placed on tailored strategies to overcome economic and time constraints (i.e., schedule/time conflicts, lack of transportation, inability to pay for parking). To fit the priorities and needs of the participants, testing was also conducted at their homes (25.3%) and nearby religious and community centers (22.8%). Participants identifying as Latino/a or Black were predominantly recruited and tested at their local community center (as requested by gatekeepers/participants) to increase access to the study, in contrast to Caucasian participants. Median income estimates were used to stratify participants by socioeconomic status (SES) based on zip codes into low SES (L-SES) or high SES (H-SES) groups.Results:Participants from the L-SES group had significantly lower total scores on the MoCA than their H-SES counterparts, t(77J=2.837, p=0.003, g=0.696. The average MoCA total score for participants from the L-SES group was 2.64 points lower. The observed differences in MoCA total score when stratifying by ethnicity may be attributable to differences in education level and SES, which are known risk factors for cognitive impairment and will be further examined upon recruitment completion.Conclusions:Studies have found that ethnically diverse older adults not only encounter more barriers to accessing quality health care but also experience disparities in brain health research. Communities of color comprise a sizeable portion of our older adults but have been traditionally underrepresented in clinical research, limiting the generalizability of research findings to clinical treatment. Socioeconomic deprivation has been identified as one of several barriers to research engagement for people of color, placing ethnic communities at increased risk for under- or misdiagnosis and limited access to medical intervention. Preliminary findings have implications for the recruitment of ethnically diverse groups in clinical research. Given the growing racial and ethnic diversity among the United States population, we must do our due diligence to increase understanding of participation and recruitment barriers for racial/ethnic individuals. Tailored community outreach and engagement strategies may be effective in improving the inclusion of ethnically diverse populations and facilitating recruitment and retention in clinical research studies.

Analysis and prediction of older adult sports participation in South Korea using artificial neural networks and logistic regression models

BackgroundKorea’s aging population and the lack of older adult participation in sports are increasing medical expenses.AimsThis study aimed to segment older adult sports participants based on their demographic characteristics and exercise practice behavior and applied artificial neural network and logistic regression models to these segments to best predict the effect of medical cost reduction. It presents strategies for older adult sports participation.MethodsA sample comprising data on 1,770 older adults aged 50 years and above was drawn from the 2019 National Sports Survey. The data were analyzed through frequency analysis, hierarchical and K-means clustering, artificial neural network, logistic regression, cross-tabulation analyses, and one-way ANOVA using SPSS 23 and Modeler 14.2.ResultsThe participants were divided into five clusters. The artificial neural network and logistic analysis models showed that the cluster comprising married women in their 60s who participated in active exercise had the highest possibility of reducing medical expenses.DiscussionTargeting women in their 60s who actively participate in sports, the government should expand the supply of local gymnasiums, community centers, and sports programs. If local gymnasiums and community centers run sports programs and appoint appropriate sports instructors, the most effective medical cost reduction effect can be obtained.ConclusionsThis study contributes to the field by providing insights into the specific demographic segments to focus on for measures to reduce medical costs through sports participation.

Landscape of loss: art therapy outdoors and traumatic bereavement

ABSTRACT Background: This paper describes art therapy sessions outdoors with a six-year-old child following multiple adverse childhood experiences and a recent bereavement of a relative who died by suicide. Context: Art therapy took place in a major city in Scotland. Sessions took place both at a local community centre and a nature reserve. Approach: Sessions employed an outdoor approach to art therapy that was underpinned by artistic concepts and ecopsychology. Outcomes: The child presented in this paper engaged notably differently when sessions were taken outside. He began to explore and communicate more coherently about his life experiences and the death of his relative. Conclusions: Through interacting with the natural environment during outdoor sessions, this child was able to explore and express concerns much more freely than during indoor sessions. Implications for Research: There is a need for further research focusing on outdoor art therapy due to a dearth of peer-reviewed research on this topic.

R1 (Resident Advocacy Project) Flexible and Enhanced Learning with our RICHER Partners: Reciprocal Partnerships between Medical Students and Equity-Deserving Communities to Promote Vaccine Access and Teach Health Advocacy

Abstract Rationale and Objectives The University of British Columbia provides medical students in years 1, 2, and 4 with protected time to explore the CanMEDs competencies in student-directed service, education, and research through the Flexible and Enhanced Learning (FLEX) program. Six FLEX students in the past three years have engaged in reciprocal partnerships with the Responsive, Intersectoral Community Child Health Education and Research group (RICHER). RICHER is a consortium of interdisciplinary healthcare providers, resource centres, and community members working across sectors and systems who serve equity-deserving children, youth, and families in Vancouver’s inner-city. Students develop leadership, health advocacy, and collaboration competencies through mentorship and co-learning with the RICHER team and community partners. For example, students have partnered to promote and amplify vaccine equity, knowledge of children’s and youth’s rights, food security, and social-emotional learning. Project Description For each FLEX project, community members identify local priorities. They conduct needs assessments and environmental scans. Students complete project proposals, ethics board and grant applications, and elicit iterative community feedback. Students collect data and communicate findings to stakeholders, including community members and RICHER clinicians. RICHER further amplifies community voices by sharing FLEX project results with local and provincial decision-makers, resulting in policy change and resource mobilization. Projects are evaluated qualitatively by stakeholders. For example, during the COVID-19 lockdown, many inner-city families faced barriers accessing COVID vaccines. The Downtown Eastside neighbourhood had some of the lowest vaccination rates in the province. Outcomes FLEX students surveyed 122 community members and found that 89 (73%) community members experienced a significant barrier to accessing COVID vaccines, such as: no access to technology or ID required to register or book an appointment, no access to transportation to a vaccine clinic, or trauma associated with accessing healthcare or injections. The RICHER team was able to respond to these findings by authoring a letter to the local health authority, who mobilized a pop-up vaccine clinic at an accessible, local community centre using the principles of brokered trust. Discussion/Future Directions This vaccine equity project has set a precedence for accessible care and created a model for future vaccine clinics to provide protection against viruses like influenza. FLEX students and hospital staff learned from Indigenous Elders and community members how to use the medicine wheel in the context of wholistic healthcare. As health advocates, FLEX students learned to ask, “who are we not seeing and why?” and learned how to write motivational letters to changemakers.

Getting Along During COVID-19: Older Adults’ Stress and Coping

ABSTRACT Older adults have been at greater risk for developing severe illness as a result of COVID-19. The intense shift toward a six-foot-distancing and orders to shelter-in-place was found to result in social isolation, potentially deteriorating the overall well-being of older adults. This study was to identify and categorize stress and coping strategies of older adults in the context of COVID-19. Using the Q-methodology, data were collected in partnership with a local community center from 40 participants (N = 40) aged 65 and older. Participants had a mean age of 73 (SD = 9.27); nearly all were female (85%), most (95%) were White, and over half lived alone (58%). Based on the results, participants were categorized into two factors (groups) using by-person factor analysis. Group one was found to adapt to a new routine despite feeling alone. Group two relied largely on religion and behavioral disengagement. Even with the homogenous sample, findings suggest an increased need for services in community centers, church groups, and assisted livings. Furthermore, future research ought to consider stress and coping strategies among men and/or persons of color, as findings from this study may have significant practice and policy implications.