Local Priorities Research Articles

Authenticities of K-pop Cover Dance Influencers in/from Bali, Indonesia

The rise of K-pop cover dancers worldwide reveals how artists creatively adapt and transform this genre to suit local priorities. This ethnographic analysis examines two K-pop cover dancer influencers in Bali to illuminate their curation of authenticities through local events and social media. One dancer generates a version of K-pop in Bali as a cosmopolitan, upper-class elite judge and modern dancer; the other exhibits the flow of K-pop from Bali to Seoul as a diasporic, queerish waacking dancer. This study foregrounds the disjunctive flow of glocalization as K-pop’s cultural capital extends beyond Korea for artistic, educational, and entrepreneurial benefits.

Culturally Local Perspectives Are Imperative to Scientific Excellence and Health Equity in Eating Disorders Research: Commentary on Monocello et al. (2024).

This commentary discusses a principal contribution of Monocello et al.'s paper presenting a cultural models approach to body fatness perceptions, which provides a rigorous and systematic means of identifying analytic categories that are locally meaningful, in contrast to categories derived from a solely universalizing perspective. In situating their work within an underrepresented population in eating disorders research-young men in South Korea-the authors step beyond the constraints of a universalizing, or etic, framework for probing how body dissatisfaction relates to eating disorder risk. The value of an alternative analytic framework, based on a culturally local, or emic, perspective on how bodies are perceived is demonstrated through the use of a cultural models approach exploring the relationship between culturally defined conceptualizations of body image and eating disorder risk. Understanding such relationships and the meanings attributed to the myriad aspects of body image through locally grounded frameworks provides an essential tool for investigators and clinicians to better understand the lived experience of body dissatisfaction and disordered eating, and also to inform more culturally salient approaches to diagnosis, treatment, and prevention. An emic approach that centers local perspectives and priorities also facilitates participation of communities underrepresented in research in knowledge production.

Rethinking the ‘local state’ and local capacity

ABSTRACT Considering the state-society relationships of local governance leads to conceptual and practical questions about local capacity to decide and pursue local priorities and meet local needs and the role of local government in these processes. In England’s extremely centralised governmental system, debates about local capacity tend to be subsumed by the constraints to which it is subject. Combining scholarship on policy capacity, local governance conjunctures over time and local government’s role within these informs conceptualisation of a plural, relational local state. This draws attention to local government’s everyday, intra-locality relations with its constituent communities, broadening a vertical, reductive perspective to a horizontal, more generative understanding of local capacity to care for place through collective practices.

Redefining active mobility from spatial to social in Singapore

IntroductionWalking is an active mobility option with health and social benefits. Many cities including Singapore are expanding pedestrian infrastructure and creating walkable neighbourhoods. But the connection of neighbourhood walkability and walking behaviour among residents, especially older adults remains less examined. The aim of this study is to examine the relationship between everyday walking behaviours and neighbourhood design characteristics. MethodsUtilising generative focus group discussions with 12 participants, including older adults, this exploratory research collected personal and collective stories on residents' walks around Singapore's high-rise, high-density public housing neighbourhoods of Tampines Town, including their attitudes, aversions, and aspects of environmental barriers and enablers for walking. ResultsAll 12 participants had walked in their neighbourhoods during the 7 days preceding the focus group discussion. A key motivation for walking in the neighbourhood was everyday life activities and needs, such as to get out of the house, walking for food, groceries, work, exercise, and health, reinforcing the pivotal role of these opportunities in residents’ active mobility life space and the availability and accessibility to these local facilities. Drawing on their everyday lived experiences, participants shared their conception of walkable neighbourhood, the adequacy of neighbourhood places for walking, the environmental barriers and enablers. Older participants spoke about walkable environments helping them to reach essential destinations safely every day and contributing to not only their physical health but also social and mental health (through contact with nature and interaction with neighbours and others within the neighbourhood). Where they would walk is often influenced by their perception of the place, sense of safety, and the presence/absence of services. ConclusionsThe findings lend local priorities for walkable neighbourhoods based on what residents think and blending social consensus. The policy implication is a need to consider both place enhancement and people's experience, including experiential micro-social and psychological aspects and their interlinkages when designing inclusive walkable neighbourhood.

Libraries Are Resilience Hubs

Problem, research strategy, and findings We explored the contributions of local public libraries to community resilience in the face of economic hardships, extreme weather events, and the COVID-19 pandemic using a survey of 415 library directors distributed through state library listservs in 13 Midwestern states, community-level census and presidential elections data, and library-specific data from the Institute of Museum and Library Services annual Public Libraries Survey. We found that public libraries provide invaluable resilience-boosting community services. They help patrons find jobs and access social services, often with one-on-one support. They act as daytime shelters during extreme heat and cold events, which is particularly important for unhoused and underhoused individuals. During the COVID-19 pandemic, they innovated to provide delocalized services and information access, such as installing WiFi hotspots. The provision of these essential resilience-boosting services is largely independent from library resources and community contexts and appear grounded in librarians’ ethos. Our research was limited to Midwestern public libraries and thus results are not generalizable to other regions, private, academic, and specialized libraries. We did not explore the possible relationships between local political majorities that could affect local government funding and priorities and local libraries’ funding sources, levels, and services. Takeaways for practice Beyond collections and information access, public libraries provide many services relevant to community and economic development and to disaster response. In addition, local public libraries act as resilience hubs in the face of economic stressors and extreme weather events, as well as during the COVID-19 pandemic, and are ready, flexible, adaptable, and willing to support patrons in times of need. Planners seeking to enhance community resilience can work with their local public libraries to build disaster preparedness and response capacity.

Research Translation to Promote Urban Health in Latin America: The SALURBAL Experience.

In highly urbanized and unequal Latin America, urban health and health equity research are essential to effective policymaking. To ensure the application of relevant and context-specific evidence to efforts to reduce urban health inequities, urban health research in Latin America must incorporate strategic research translation efforts. Beginning in 2017, the Urban Health in Latin America (SALURBAL) project implemented policy-relevant research and engaged policymakers and the public to support the translation of research findings. Over 6 years, more than 200 researchers across eight countries contributed to SALURBAL's interdisciplinary network. This network allowed SALURBAL to adapt research and engagement activities to local contexts and priorities, thereby maximizing the policy relevance of research findings and their application to promote policy action, inform urban interventions, and drive societal change. SALURBAL achieved significant visibility and credibility among academic and nonacademic urban health stakeholders, resulting in the development of evidence and tools to support urban policymakers, planners, and policy development processes across the region. These efforts and their outcomes reveal important lessons regarding maintaining flexibility and accounting for local context in research, ensuring that resources are dedicated to policy engagement and dissemination activities, and recognizing that assessing policy impact requires a nuanced understanding of complex policymaking processes. These reflections are relevant for promoting urban health and health equity research translation across the global south and worldwide. This paper presents SALURBAL's strategy for dissemination and policy translation, highlights innovative initiatives and their outcomes, discusses lessons learned, and shares recommendations for future efforts to promote effective translation of research findings.

Is neocolonialism existing in global surgery practice? An analysis of a web-based survey amongst global surgery practitioners

Background There is an ongoing discussion for decolonization of global health and a resetting of global health partnerships and practices. However, a lack of understanding and agreement on the issues involved remain a major limitation. The aim of this study was to understand and identify the manifestations of neocolonialism in global surgery practice. Methods This was a qualitative web-based survey of 445 low-and middle-income countries (LMICs) and high-income countries (HICs) global surgery practitioners. We also captured through focussed interviews their perceptions and reported manifestations of neocolonialism in global surgery. Results The majority (73.9%) came from LMICs, while 26.1% were from HICs. Surgeons formed the largest group (57.6%), with many having extensive experience (38.7% with over 10 years in global surgery). Neocolonialism was defined as an unequal power dynamic favoring HIC agendas. Uncompensated work by LMICs staff and funding disparities were identified as neocolonial practices by HICs participants. Limited research capacity and frustrated LMICs providers were seen as consequences. Factors enabling neocolonialism included limited local funding and training priorities set by funders, not local needs. More than 75% of participants agreed that fear of losing HIC support was a major barrier to open communication about neocolonialism in global surgery. Conclusions This study among global surgery players unbderscores existence and experiences of neocolonialism in global surgery. The impact of this practice and the enablers need to be urgently addressed by implementing mitigating solutions.

Equitable Prevention Science and Participatory Co-Design of the HEROES Strength-Based Programs

Latinx populations are disproportionately impacted by health disparities and are underserved in formal mental health and health systems. Participatory co-design of prevention and health promotion programs may better attend to cultural and systemic factors impacting access and effectiveness. Participatory methodologies offer an opportunity for prevention science researchers to empower and follow the expertise of communities to shape prevention and health promotion programs. Using community-based participatory research (CBPR) puts an emphasis on the local context and priorities related to health equity, whereas implementing human-centered design (HCD) processes provides strategies for the generation and co-design of innovative solutions. In the current study, Latinx youth, youth mentors, and promotores de salud (lay health workers) engaged in the process of co-designing two strength-based caregiver and youth prevention programs through a six-step CBPR + HCD approach. In the first phase, Latinx adolescents collaborated with researchers to co-design a six-module participatory photography program. In the second phase, youth mentors and promotores collaborated with researchers to co-design a four-module family resilience program, incorporating mindfulness, restorative communication, and child-directed interaction skills. Participatory co-design is a promising approach to developing and refining culturally congruent, community-embedded programs, while centering community priorities and meeting the preferences and needs of Latinx communities. Implications for participatory and design frameworks to better address prevention and health promotion and future research are discussed.

Implications of fisher perceptions on coral restoration in Tondol, northwestern Philippines

Increasing coral restoration efforts globally have been aimed at improving reef status and the ecosystem functions and services they provide, including enhancing reef fish communities and fisheries production on nearby reefs. However, empirical evidence showing the influence of coral restoration on fish stocks is limited. In Barangay Tondol, a small-scale fishing village in the northwestern Philippines, fisher knowledge and perception studies were completed through individual interviews to provide insights into the perceived impacts of local restoration efforts on coral reef conditions and fishery outputs. The influence of fishers' social demographics and fishery information to their held perceptions were also explored. Fishers’ responses showed a perceived decline in fish stocks over the last 5–10 years mainly attributed to overharvesting, and a slight improvement in coral reef condition due to a reduction in destructive fishing. Out of 53 fisher respondents, 72% were aware of coral restoration efforts in their area and held positive perceptions that theoretically, conducting coral restoration can improve their fish stocks and local reef conditions through the provision of habitat functions. Perceived actual effectiveness of the local efforts was also positive, but with a lower number of responses. Multiple hierarchical regression tests showed that, among social demographics, fishery information, and perceptions on fish stocks, perceived improvement in coral condition was associated with stronger support for coral restoration activities. These findings indicate that fishers perceive positive effects of coral restoration to local coral status and fisheries, and highlight the need for restoration practitioners to engage early on with key stakeholders to assess local fisheries status and local priorities to inform restoration strategies.

Attaining Equity of Access to Research: Perspective on Research in Pregnancy and Breastfeeding Following Dolores Shockley Lecture at ASCPT2024.

Everybody deserves access to evidence-based information to make decisions about their health. However, in many situations, clinical trial eligibility criteria mean that specific data do not exist for certain groups of individuals. These include pregnant and breastfeeding women, children, older people, those with hepatic and renal dysfunction, those with acute severe illness, and those with multiple co-morbidities and interacting medications. Resultantly, there may not be specific drug-dosing information for many patients who are treated in a clinical setting. The ASCPT2024 Dolores Shockley Lecture focused on the equitable access to research with a specific focus on clinical pharmacology studies in pregnancy and breastfeeding. To ensure the safe, effective use of medication in pregnancy and breastfeeding, women should be included in clinical trials and pharmacokinetic studies when a medication is anticipated to be used in women of childbearing potential. Community groups should be involved at all stages of research to maintain transparency and trust. This ensures that local priorities are investigated, that communities understand the findings and are empowered to make evidence-based decisions about their own medication use. Principles informing the design of such studies in pregnancy and lactation are in existence. Mathematical techniques such as physiologically-based pharmacokinetic modeling and stochastic simulation and estimation can enhance study design, and population pharmacokinetic modeling be used to understand variability within and between individuals. Data should be made findable, accessible, interoperable, and reusable (FAIR). Information (and where necessary, training) regarding the use of these approaches should be provided to decision-making stakeholders such as ethics committees and regulatory bodies.

Etiology of hospital mortality in children living in low- and middle-income countries: a systematic review and meta-analysis.

In 2019, 80% of the 7.4 million global child deaths occurred in low- and middle-income countries (LMICs). Global and regional estimates of cause of hospital death and admission in LMIC children are needed to guide global and local priority setting and resource allocation but are currently lacking. The study objective was to estimate global and regional prevalence for common causes of pediatric hospital mortality and admission in LMICs. We performed a systematic review and meta-analysis to identify LMIC observational studies published January 1, 2005-February 26, 2021. Eligible studies included: a general pediatric admission population, a cause of admission or death, and total admissions. We excluded studies with data before 2,000 or without a full text. Two authors independently screened and extracted data. We performed methodological assessment using domains adapted from the Quality in Prognosis Studies tool. Data were pooled using random-effects models where possible. We reported prevalence as a proportion of cause of death or admission per 1,000 admissions with 95% confidence intervals (95% CI). Our search identified 29,637 texts. After duplicate removal and screening, we analyzed 253 studies representing 21.8 million pediatric hospitalizations in 59 LMICs. All-cause pediatric hospital mortality was 4.1% [95% CI 3.4%-4.7%]. The most common causes of mortality (deaths/1,000 admissions) were infectious [12 (95% CI 9-14)]; respiratory [9 (95% CI 5-13)]; and gastrointestinal [9 (95% CI 6-11)]. Common causes of admission (cases/1,000 admissions) were respiratory [255 (95% CI 231-280)]; infectious [214 (95% CI 193-234)]; and gastrointestinal [166 (95% CI 143-190)]. We observed regional variation in estimates. Pediatric hospital mortality remains high in LMICs. Global child health efforts must include measures to reduce hospital mortality including basic emergency and critical care services tailored to the local disease burden. Resources are urgently needed to promote equity in child health research, support researchers, and collect high-quality data in LMICs to further guide priority setting and resource allocation.

The State of Surgical Research in Sub-Saharan Africa: An Urgent Call for Surgical Research Trainers.

Surgery in low- and middle-income countries (LMICs) is poorly developed because of years of neglect. Sustained research on global surgery led to its recognition as an indivisible and indispensable part of primary healthcare in 2015. However, this has had little visible effect on surgical ecosystems within LMICs, especially in sub-Saharan Africa (SSA). SSA surgical research systems strengthening, which includes skills transfer, with local priority setting driving the research agenda, is needed to propel global surgery into the future. The authors performed a literature review of the state of surgical research within SSA and also report the initial efforts of two research training nonprofits to empower young African surgeons with research skills. Surgical research in SSA is disadvantaged even before it is birthed, facing monumental challenges at every stage of development, from research agenda determination to funding, study execution, and publication. Compared with a global output of 17.49 publications per 100,000 population, SSA produces 0.9 (P < 0.0001). The Surgeons in Humanitarian Alliance for Reconstructive, Research, and Education and Enabling Africa Clinical Health Research programs are involved in the longitudinal research mentorship of surgical residents within SSA; the improved quality of research and successful publications by participants suggest nascent steps in growing young surgical scientists. In the absence of an existing surgical research infrastructure within LMICs, global surgery research trainers should link up and collaborate to help develop a surgical research community that will provide the local data required to help transform the SSA surgical ecosystem.

IDEA tool: Establishing a prioritisation matrix for oral health improvement interventions.

Initial impetus for action: Oral health is not equitably distributed. More deprived areas experience appreciably worse oral health outcomes. Oral health improvement programmes in Local Authorities (LA) seek to reduce these inequalities but have diminished in recent years following the COVID-19 pandemic. LAs have also endured funding cuts to public health budgets, placing a greater emphasis on the need for establishing a clear prioritisation matrix for oral health improvement interventions. Solution: A prioritisation matrix that considered both the importance and do-ability of oral health improvement interventions was developed. Both are composite measures. The importance comprised evidence of benefit, impact on inequalities, alignment with national/local priorities and cost-effectiveness of the intervention. The do-ability considered the available support from stakeholders, building/equipment requirements, workforce issues and investment funding. A working group was necessary to inform the do-ability aspect of the prioritisation matrix. Scores were assigned to each criterion, the sum of the scores informed whether the intervention was eliminated, aspirational or implemented based on predetermined thresholds. Outcome: The prioritisation matrix ensured a transparent and systematic approach for intervention selection, which reflected local resources and priorities. Moreover, this tool should help ensure the most effective, equitable, practical and sustainable interventions are chosen having the greatest impact on improving oral health outcomes.

The Effect of Using Waqf for Infrastructure and Education on Achieving Sustainable Development Goals in West Java

This qualitative study investigates the utilization of Waqf for infrastructure and education in achieving Sustainable Development Goals (SDGs) in West Java, Indonesia. Through in-depth interviews with ten stakeholders, including government officials, Waqf administrators, community leaders, educators, and representatives from non-profit organizations, the study explores perceptions, challenges, opportunities, and impacts associated with Waqf-based initiatives. The findings reveal positive perceptions of Waqf as a resource for development, alongside challenges such as regulatory barriers, governance issues, and coordination gaps. Opportunities for leveraging Waqf include public-private partnerships, technology-enabled solutions, innovative financing mechanisms, community engagement, and policy reforms. Despite challenges, Waqf initiatives have contributed to infrastructure development, education provision, poverty alleviation, community empowerment, and environmental sustainability in West Java. The study underscores the need for regulatory reforms, enhanced governance structures, collaboration among stakeholders, technological innovations, and alignment with local development priorities to maximize the impact of Waqf on sustainable development goals.

#294 Pragmatic literature reviews to populate a patient-level model to project the future clinical burden of CKD in low-and middle-income countries

Abstract Background and Aims Chronic Kidney Disease (CKD) affects approximately one in ten people around the world and is associated with an increased risk of adverse cardiorenal outcomes and mortality. In low- and middle-income countries (LMICs), the situation is aggravated by the paucity of kidney replacement therapies (KRTs). The objective of this study was to review the literature around CKD prevalence to understand the future epidemiology and economic burden of CKD in four LMICs from different continents. Method Inside CKD is a project designed to perform a microsimulation on a representative patient cohort to simulate renal disease progression into the future, and to model the effects of interventions based on population and disease characteristics. A pragmatic literature review was performed to obtain the inputs required to adapt the Inside CKD model to project the epidemiological and economic burden of CKD in four World Bank (2022) classified LMICs (Bolivia, Kenya, Sri Lanka and Uzbekistan). Using a data quality scoring system designed for the Inside CKD programme, a model input template was created to guide the country-specific literature search, to identify country demographics, epidemiological data including CKD staging data, renal registries, comorbidities (type 2 diabetes and hypertension), complications data (stroke, myocardial infarction, heart failure) and economic data including health costs and quality-of-life measures. Additional needs, challenges or country specific risk factors have also been identified. Results Literature reviews identified the best sources of demographic, epidemiological data as well as the main drivers of CKD in the four countries (e.g. hypertension, type 2 diabetes, heart failure). In addition, the reviews identified the best proxy data to use when country-specific data was not available. The UN World Prospects database was selected to derive the current and future population dynamics in the four countries. For Kenya, data from local sources, sub-Saharan African and Uganda were utilised to estimate the primary drivers of CKD: a 2018 meta-analysis reported a CKD prevalence of 18% in sub-Saharan Africa and was used to derive the eGFR and UACR data required to project CKD prevalence. CKD prevalence by stage was also identified for Bolivia. A large-scale study across 12 countries with consistent methodology estimated a CKD prevalence of around 5.5% in Bolivia. CKD data from Kazakhstan was selected as a proxy for Uzbekistan, which had a low prevalence of 1.3%. Country-specific challenges were also identified: in Kenya, results showed the importance of malnutrition, infection and climate as key drivers of CKD. In Sri Lanka and Uzbekistan, environmental factors (air and water pollution) and agricultural activity may contribute to high CKD prevalence in rural areas alongside more common risk factors such as hypertension. In Sri Lanka, CKD has been estimated at around 8.2% in the general population versus 15.0% in areas where groundwater is consumed. For Bolivia, additional parameters including occupation, altitude, seasonal weather variation and extreme temperatures may exacerbate CKD risk. Conclusion CKD is a major public health problem in LMICs but with diverse drivers. Local capacities and healthcare financing priorities vary between regions and depend upon competing demands of acute conditions, infections and non-communicable diseases. Forecasting future CKD burden is helpful for policy and planning purposes. There is a clear need to tailor policies beyond early screening and proactive management to tackle country-specific challenges such as occupation, infection, seasonal weather variation and genetics.

Democratising local values and priorities in regional landscape planning: a Danish strategy-making case

This article analyses and discusses how to develop contemporary methods to conduct democratic and sustainable planning in rural landscapes based on place-making, collaborative planning and strategy-making. The analysis is based on a Danish regional strategy-making case, the Nørreådalen river valley (NRV), which is used to explore how to democratically incorporate local values and establish sustainable development priorities. The NRV case highlights the significance of cultivating a shared frame of reference to foster inclusive and informed landscape strategies, which underscores the importance of understanding diverse values and their holders in landscape governance. Collaborative strategy-making may serve as a powerful method for addressing complex challenges and fostering sustainable development in rural landscapes provided it is tailored to the specific contextual considerations and nurtures a comprehensive understanding of shared landscape values.

Researching local public health priorities in the locked down city using online community focus groups: Reflections and recommendations

In this commentary paper we reflect on our experiences of conducting two qualitative public health projects in Leicester UK around health inequalities and marginalised groups during the Covid 19 pandemic in 2020 and 2021. To contextualise the commentary, we first provide information about Leicester and how and why it was disproportionately affected by the pandemic, as well as describing the origins, aims, and methodologies of the two projects. In the second half, we describe and evaluate some of the adaptations we made to our studies and conclude with suggestions for future qualitative community health research as we adapt to the post-pandemic research landscape.

The potential for local environmental governance: A case study of Natural Cambridgeshire

There are demands on land to provide a variety of ecosystem services alongside agricultural products. In the absence of markets, delivery is generally overseen through separate agencies. However, synergies and trade-offs amongst ecosystem services and variation across space lead to different priorities and opportunities in different areas. This creates a complex challenge for governance and implies a need to devolve decision-making.The objective of this paper is to explore the devolution of decision-making through the introduction of Local Environmental Governance Organisations (LEGO). A LEGO would assemble evidence on natural capital and co-ordinate stakeholders to identify local priorities. It would search for synergies and collaborative partnerships and raise funds to support priority actions.The paper first sets out a theoretical framework to identify the elements required for local governance. It then proposes two alternatives: a ‘national park’ approach for areas of higher environmental quality and a ‘local nature partnership’ approach elsewhere. The paper then provides a case study of Natural Cambridgeshire, a local nature partnership in England, as a potential LEGO, assessing the extent to which it meets the requirements identified. It has already done much to develop a stakeholder community and has begun to establish priorities for nature enhancement. However, it lacks programmes and long term funding that can incentivise the necessary actions or a forum that can bring together partners for Nature-based Solutions at scale.Central government would need to establish a framework for the operation of a system of LEGOs. It would also continue to support national standards.

Project ECHO®: a global cross-sectional examination of implementation success

BackgroundOrganizations implement innovations to disrupt the status quo and create value. Within sectors such as healthcare, innovations need to navigate large scale system and organizational factors to succeed. This research explores the implementation of a global innovation– Project ECHO®. Project ECHO® is a validated virtual communities of practice model organizational teams implement to build workforce capacity and capability. Project ECHO® has experienced broad global adoption, particularly within the healthcare sector, and is experiencing growth across other sectors. This study sought to examine the state of implementation success for Project ECHO® globally, to understand how these implementations compare across geographic and sectoral contexts, and understand what enablers/barriers exist for organizational teams implementing the innovation.MethodsAn empirical study was conducted to collect data on 54 Project ECHO® implementation success indicators across an international sample. An online survey questionnaire was developed and distributed to all Project ECHO® hub organizations globally to collect data. Data was analyzed using descriptive statistics.ResultsThe 54 implementation success indicators measured in this survey revealed that the adoption of Project ECHO® across 13 organizations varied on a case-by-case basis, with a strong rate of adoption within the healthcare sector. Implementation teams from these organizations successfully implemented Project ECHO® within 12–18 months after completing Immersion partner launch training and operated 51 ECHO® Networks at the time of data collection. Implementation teams which liaised more regularly with ECHO® Superhub mentors often went on to launch a higher number of ECHO® Networks that were sustained over the longer term. This suggests that these implementation teams better aligned and consolidated their Project ECHO® pilots as new innovations within the local context and strategic organizational priorities. Access to research and evaluation capability, and a more automated digital client relationship management system were key limitations to showcasing implementation success outcomes experienced by the majority of implementation teams.ConclusionsThese findings make a valuable contribution to address a knowledge gap regarding how a global sample of organizations adopting Project ECHO® measured and reported their implementation successes. Key successes included pre-launch experimentation and expansion, Superhub mentorship, stakeholder engagement, and alignment to strategic priorities.

Building a systems-thinking community workforce to scale action on determinants of health in New Zealand

This article describes findings from the evaluation of Healthy Families NZ (HFNZ), an equity-driven, place-based community health initiative. Implemented in nine diverse communities across New Zealand, HFNZ aims to strengthen the systems that can improve health and well-being. Findings highlight local needs and priorities including the social mechanisms important for reorienting health and policy systems towards place-based communities. Lessons encompass the importance of local lived experience in putting evidence into practice; the strength of acting with systems in mind; the need for relational, learning, intentional, and well-resourced community organisation; examples of how to foster place-based ‘community-up’ leadership; and how to enable responsiveness between communities and local and national policy systems. A reconceptualisation of scaling in the context of complexity and systems change is offered, which recognises that relationships and agency are key to making progress on the determinants of health.