Meet Community Health Research Articles

Linking Interprofessional Community Health Experiences With Nursing Education: 15 Years and Counting.

Ensuring that nurses and other health care professionals are trained to work together in teams is critical. Recent literature describes interprofessional education (IPE) programs that meet community health needs. However, there is a need for descriptions of IPE programs embedded in the communities they serve. Bridging the Gaps (BTG) is a collaboration between academic health institutions/universities and community organizations in the northeastern United States. BTG links IPE with the provision of health-related services for under resourced communities. This article describes the development of one BTG Community Health Internship Program (BTG CHIP) affiliate site (BTG, Lehigh Valley). Since inception, 114 interns completed the program as part of BTG CHIP, Lehigh Valley, for a total of 3192days of service provided to the community. BTG CHIP, Lehigh Valley, serves as a case study for establishing similar community-based IPE programs. This article describes challenges, opportunities, and replication strategies.

Funding and Delivery of Syringe Services Programs in the United States, 2022.

Objectives. To describe the current financial health of syringe services programs (SSPs) in the United States and to assess the predictors of SSP budget levels and associations with delivery of public health interventions. Methods. We surveyed all known SSPs operating in the United States from February to June 2022 (n = 456), of which 68% responded (n = 311). We used general estimating equations to assess factors influencing SSP budget size and estimated the effects of budget size on multiple measures of SSP services. Results. The median SSP annual budget was $100 000 (interquartile range = $20 159‒$290 000). SSPs operating in urban counties and counties with higher levels of opioid overdose mortality had significantly higher budget levels, while SSPs located in counties with higher levels of Republican voting in 2020 had significantly lower budget levels. SSP budget levels were significantly and positively associated with syringe and naloxone distribution coverage. Conclusions. Current SSP funding levels do not meet minimum benchmarks. Increased funding would help SSPs meet community health needs. Public Health Implications. Federal, state, and local initiatives should prioritize sustained SSP funding to optimize their potential in addressing multiple public health crises. (Am J Public Health. 2024;114(4):435-443. https://doi.org/10.2105/AJPH.2024.307583).

Rapid evidence assessment of student-assisted assessment and brief intervention clinics: Addressing the gaps in rural and remote health care.

With high disease and disability burden in rural and remote regions, student-assisted clinics can be an effective workforce development tool to meet community health needs and workforce shortages. This research sought to identify the conditions under which student-assisted clinics can be successfully utilised as a workforce development strategy, with specific application to remote Queensland, Australia. A rapid review of the international literature in English was conducted. This was the most appropriate type of review because the results of the review were time-sensitive, with the student-assisted clinic model being trialled in Queensland soon. A mixed methods design was applied, with the search strategy piloted with one database. Eleven studies met the inclusion criteria. Seven reported data on participant experiences, including consumers, students, services/clinics, and educators/supervisors/health professionals. Each of the studies operationalised student-assisted clinics through practice models (university-driven learning need), service delivery models (service driven need addressed through a student workforce), community need models (student delivered services primarily addressing a community health need), and blended models (practice need and community need). Some studies reported concerns about fragmentation of services, referral pathways and issues with follow-up, while others reported concerns about sustainable funding. All models reported successful outcomes when focused on service or consumer health outcomes, or student learning outcomes. Student-assisted clinics make an important contribution to the development of the rural and remote health workforce. Student-assisted clinics can complement and extend existing services, supporting workforce development in an overstretched health system impacted by an ongoing pandemic.

Morristown Memorial Hospital: The Nonprofit Property Tax Exemption Debate

ABSTRACT This case highlights nonprofit hospital organizations’ changing roles and relationships with their tax-exempt status and the communities they serve. Historically, nonprofit hospitals justified tax exemption by meeting community health needs but have evolved into extensive partnerships with for-profit organizations to obtain the resources necessary to provide state-of-the-art care. Unfortunately, these arrangements have raised issues regarding tax-exempt status, making nonprofit hospitals an increasing target of property tax exemption challenges for cash-strapped municipalities. This was the case when the property tax exemption of Morristown Memorial Hospital was called into question. The New Jersey Tax Court pointed to a complex structure in which nonprofit and for-profit interests were inextricably intertwined. It is held that, if modern nonprofit hospitals operate like this, they are essentially legal fiction. Students assess whether the Hospital satisfies the criteria for property tax exemption and debate the legitimacy of tax exemption given the changing nature of nonprofit hospital operations. Data Availability: Data are available from the public sources cited in the text. JEL Classifications: H22; H71; H75; I18; K34; L31.

Motivations for Pursuing Enhanced Skill Credentials in Family Medicine: A Study of the Certificates of Added Competence in Canada.

The College of Family of Physicians of Canada's Certificates of Added Competence (CACs) denote enhanced-skill family physicians who function beyond the scope of family practice or in specialized areas fundamental to family medicine practice. The credential provides recognition for skill development in areas of need and is intended to augment comprehensive care; however, there are concerns that it increases focused practice and decreases commitment to generalist care. To inform credentialing policies, we elucidated physician and trainee motivations for pursuing the CAC credential. We conducted secondary analyses of interview data collected during a multiple case study of the impacts of the CACs in Canada. We collected data from six cases, sampled to reflect variability in geography, patient population, and practice arrangement. The 48 participants included CAC holders, enhanced-skill family physicians, generalist family physicians, residents, specialists, and administrative staff. We subjected data to qualitative descriptive analysis, beginning with inductive code generation, and concluding in unconstrained deduction. Family physicians and trainees pursue the credential to meet community health care needs, limit or promote diversity in practice, secure perceived professional benefits, and/or validate their sense of expertise. Notably, family physicians face barriers to engaging in enhanced skill training once their practice is established. While the CACs can enhance community-adaptive comprehensive care, they can also incentivize migration away from generalist practice. Credentialing policies should support enhanced skill designations that respond directly to pervasive community needs.

The uptake and outcomes of an online self-help mindfulness programme during COVID-19

ABSTRACT Objectives The COVID-19 pandemic has had negative mental health impacts. Online psychological interventions can facilitate rapid access to mental health resources. This study examined the outcomes of a 4-lesson, self-help online mindfulness course during the early months of the pandemic in Australia. Methods 5058 adults commenced the Introduction to Mindfulness course and completed measures of psychological distress (Kessler-10) and wellbeing (Short Warwick-Edinburgh Mental Well-being Scale). 3696 individuals commenced their course between 2016 and 2019 (“pre-COVID” group), while 1362 started their course between 12 March 2020 and 31 July 2020 (“during-COVID” group). Results Participants in the during-COVID-pandemic group reported slightly lower levels of psychological distress and higher levels of wellbeing compared to the pre-COVID group. In both groups, the mindfulness course was associated with medium effect size reductions in psychological distress (g = .49-.55) and small effect size improvements in wellbeing (g = .27-.41). Conclusions The mindfulness course was associated with reduced psychological distress before and during the pandemic. Results underscore the generalisability of online mindfulness interventions to pandemic situations. KEY POINTS What is already known about this topic: The mental health impacts associated with the COVID-19 pandemic have been substantial. Mental health service provision has adapted to meet community health needs in the wake of the pandemic. It is unclear if the effectiveness of online mental health interventions will generalise topandemic conditions. What this paper adds: The outcomes of an online mindfulness course were explored. The course was associated with improved psychological distress and wellbeing both before and during the COVID-19 pandemic in Australia. Results highlight the utility of digital mental health services during COVID-19.

Mental Health Appointments in the Era of COVID-19: Experiences of Patients and Providers.

Background: The coronavirus disease 2019 (COVID-19) pandemic brought an unprecedented shift in health care toward telepsychiatry. This worldwide phenomenon was necessary to meet community health needs while prioritizing patient and provider safety. This study explored the impact of changes in delivery of mental health care services during the pandemic on patient and provider satisfaction with care.Methods: Providers and patients at an academic outpatient psychiatric clinic completed an electronic, cross-sectional, anonymous survey. Items probed perceived convenience and comfort with in-person and telehealth visits, COVID-19–related depression and anxiety, and visit modality preferences.Results: The response rate was 80.0% for providers and 21.0% for patients. Providers found telehealth more convenient than in-person visits during the pandemic, t(11)=1.66, P=0.024. Patients reported no differences in convenience (P=0.497) or comfort (P=0.535) ratings. As the pandemic continues, 83.3% of providers and 50.0% of patients indicated they would prefer telehealth visits. Only 16.7% of providers and 25.0% of patients would prefer telehealth visits continue after the pandemic. Preferred appointment type during the pandemic was not significantly correlated with pandemic-related anxiety or depression.Conclusion: Providers showed a strong preference for telehealth visits during the pandemic, whereas patients felt equal convenience and comfort with care in both telehealth and in-person visits. Fewer participants preferred to use the telehealth modality after the pandemic ends. Higher COVID-19–related depression or anxiety did not impact preference toward visit type. These results suggest that telepsychiatry is an acceptable, although not always preferred, modality for psychiatric care during the global pandemic.

Integrating Community and Clinical Data to Assess Patient Risks with A Population Health Assessment Engine (PHATE)

Clinicians are concerned about their patients' social determinants of health (SDH); yet, they are unsure how to effectively gather patient-level SDH data and intervene without adding to current administrative burdens. Designed properly, clinical registries offer solutions to integrate neighborhood SDH data with clinical data from electronic health records, enabling the understanding of community factors to guide patient care. Federal and state interest in adjusting reimbursements based on SDH further underscores the need for strategies that integrate SDH and clinical data. The Population Health Assessment Engine (PHATE) exemplifies a registry-based SDH data integration solution that adjusts payments, contributes to public health surveillance, organizes care around hot spots (gaps in quality or uncontrolled disease), assesses patient risk, and connects with community organizations. PHATE also permits residency training to meet community health competency milestones by incorporating the PHATE curriculum. These functions enhance value, and their utility in education and care delivery would benefit from further investigation.

Health-related quality of life (HRQoL) associated with echinococcosis patients in Tibetan communities in Shiqu County, China: a case-control study.

Echinococcosis is a chronic neglected zoonotic disease with high endemic in western China. The aim of the study was to evaluate the Health-related Quality of Life (HRQoL) in patients with echinococcosis in Tibetan communities for investigating the physical and mental health challenges faced by the echinococcosis patients and meeting community health needs. The HRQoL was measured with 36-Item Short Form Health Survey (SF-36) questionnaire in the case-control study. Analysis of variance (ANOVA) method was used to analyze the data. 50 echinococcosis patients were collected in study group and divided into three subgroups by the duration of staying on albendazole tablets. 52 healthy individuals were collected in control group. In physical quality of life, the duration of staying on albendazole tables influenced the PF (F = 6.661, P < 0.001), RP (F = 3.130, P = 0.029), and GH (F = 4.105, P = 0.008). In mental quality of life, the duration of staying on albendazole tables influenced the SF (F = 10.764, P < 0.001) and RE (F = 5.573, P = 0.001). The income level was the important confounder in PF (F = 11.515, P = 0.001), GH (F = 10.315, P = 0.002), VT (F = 5.984, P = 0.016), and MH (F = 5.565, P = 0.020). The HRQoL in people with echinococcosis is reduced in comparison with the healthy individuals. It is necessary to shorten the duration of treatment and adopt the special methods adapting the local culture to improve the health-related quality of life in Tibetan communities. Meanwhile, the economic improvement is the foundation.

New Methodologies for Global Health Research: Improving the Knowledge, Attitude, and Practice Survey Model Through Participatory Research in Haiti.

Knowledge, attitude, and practice (KAP) survey models are a common tool used by researchers and global health practitioners to reveal insights necessary for health program design and implementation. We explore how an interdisciplinary team of medical practitioners, researchers, designers, and community members improved the KAP survey tool in Haiti by drawing on participatory research methods. The overall objective of the project was to build a new approach to investigating and meeting community health needs and specifically the challenges faced by women with breast and cervical cancer in Haiti. The research findings were used to design an education tool kit for health care providers as well as create a community-based engagement strategy to better connect people to cancer screening and treatment facilities. By infusing the KAP survey model with participatory approaches to knowledge production, the advisory board designed a survey tool that generated more relevant and in-depth knowledge with the community while maintaining the study's simplicity and complying with a time-limited budget.

What is the overall impact or effectiveness of visiting primary health care services in rural and remote communities in high-income countries? A systematic review

BackgroundVisiting services address the problem of workforce deficit and access to effective primary health care services in isolated remote and rural locations. Little is known about their impact or effectiveness and thereby the extent to which they are helping to reduce the disparity in access and health outcomes between people living in remote areas compared with people living in urban regions of Australia. The objective of this study was to answer the question “What is the impact or effectiveness when different types of primary health care services visit, rather than reside in, rural and remote communities?”MethodWe conducted a systematic review of peer-reviewed literature from established databases. We also searched relevant websites for ‘grey’ literature and contacted several key informants to identify other relevant reference material. All papers were reviewed by at least two assessors according to agreed inclusion and exclusion criteria.ResultsInitially, 345 papers were identified and, from this selection, 17 papers were considered relevant for inclusion. Following full paper review, another ten papers were excluded leaving seven papers that provided some information about the impact or effectiveness of visiting services. The papers varied with regard to study design (ranging from cluster randomised controlled trials to a case study), research quality, and the strength of their conclusions. In relation to effectiveness or impact, results were mixed. There was a lack of consistent data regarding the features or characteristics of visiting services that enhance their effectiveness or impact. Almost invariably the evaluations assessed the service provided but only two papers mentioned any aspect of the visiting features within which service provision occurred such as who did the visiting and how often they visited.ConclusionsThere is currently an inadequate evidence base from which to make decisions about the effectiveness of visiting services or how visiting services should be structured in order to achieve better health outcomes for people living in remote and rural areas. Given this knowledge gap, we suggest that more rigorous evaluation of visiting services in meeting community health needs is required, and that evaluation should be guided by a number of salient principles.

Performance and self-perceived competencies of enrolled nurse/midwives: a mixed methods study from rural Tanzania

BackgroundTanzania is experiencing a severe shortage of human resources for health, which poses a serious threat to the quality of health care services particularly in rural areas. Task shifting has been considered a way to address this problem. However, since a large percentage of health care providers in rural setting is comprised of Enrolled Nurse/Midwives (ENMs), most of the health care tasks are shifted to them. This article analyzes the performance and self-perceived competencies of ENMs at the dispensary level; the lowest health facility in Tanzania. Performance refers to routine duties performed by ENMs, and self-perceived competence means self-perceived proficiency in performing nursing/midwifery and medical duties.MethodsThis was a mixed methods study conducted in rural Tanzania. A purposeful sample of twelve (12) informants (six ENMs; two Community Leaders [CLs] and four Dispensary In-charges [DIs]) was recruited for semi-structured interviews. The interviews were supplemented with quantitative data from 59 ENMs. Both thematic and descriptive analysis approaches were used.ResultsThree themes emerged: (1) ‘Approval of the performances of ENMs in meeting community health needs’ underscores important services the community members got from ENMs at dispensaries. (2) ‘Experienced difficulties of meeting community health needs’ indicate the problems ENMs encountered while providing services to the community. In striving to serve a large number of demanding clients without adequate medical equipment and supplies, sometimes the ENMs ended up with prescription errors (3) ‘Appreciating the performances and competencies of ENMs’ shows the acknowledgement of community members towards ENMs’ performance and competencies within and beyond their scope of practice. The community members as well as ENMs and their supervisors knew that ENMs must sometimes provide care that is outside their scope of training and competency. Overall, the performance among ENMs above 38 years of age (P < 0.05) and participants of professional development courses (P < 0.01) was high.ConclusionsThe results highlight performance and self-perceived competencies of ENMs in struggling to meet community health needs. Additionally, these results highlight the health care system shortfalls in supporting and developing an adequate number of qualified health care professionals so that health care needs of all citizens, including those in rural areas, are met.

Providers Can Meet Community Health Needs as Independent Partners.

Providers Can Meet Community Health Needs as Independent Partners.

A Review of Tools to Assist Hospitals in Meeting Community Health Assessment and Implementation Strategy Requirements

Recent changes in U.S. national policies and regulations have created an opportunity for meaningful collaborations to take place between health systems, public health departments, and social service organizations. For medical systems, and particularly tax-exempt hospitals, new requirements include community health assessments (CHAs) and implementation strategies to address identified health needs. Individuals and groups responsible for meeting the new CHA and implementation strategy requirements may be unsure about the best ways to achieve specific aspects of the CHA process. In this report, we provide an in-depth review and rating of tools developed by public health and community experts that cover the steps necessary to meet the new requirements. A team of three community and public health experts and the authors developed a rating sheet based on a well-known community health improvement process model and on the steps in the new requirements to identify and systematically rate nine comprehensive tools. The ratings and recommendations provide a guide for hospitals in choosing tools that will best assist them in meeting the new requirements.

Disaster Vulnerability of Hospitals: A Nationwide Surveillance in Japan.

Hospital preparedness against disasters is key to achieving disaster mitigation for health. To gain a holistic view of hospitals in Japan, one of the most disaster-prone countries, a nationwide surveillance of hospital preparedness was conducted. A cross-sectional, paper-based interview was conducted that targeted all of the 8701 registered hospitals in Japan. Preparedness was assessed with regard to local hazards, compliance to building code, and preparation of resources such as electricity, water, communication tools, and transportation tools. Answers were obtained from 6122 hospitals (response rate: 70.3%), among which 20.5% were public (national or city-run) hospitals and others were private. Eight percent were the hospitals assigned as disaster-base hospitals and the others were non-disaster-base hospitals. Overall compliance to building code, power generators, water tanks, emergency communication tools, and helicopter platforms was 90%, 84%, 95%, 43%, and 22%, respectively. Major vulnerabilities in logistics in mega-cities and stockpiles required for chronic care emerged from the results of this nationwide surveillance of hospitals in Japan. To conduct further intensive surveillance to meet community health needs, appropriate sampling methods should be established on the basis of this preliminary study. Holistic vulnerability analysis of community hospitals will lead to more robust disaster mitigation at the local level.

Correction: Meeting Community Health Worker Needs for Maternal Health Care Service Delivery Using Appropriate Mobile Technologies in Ethiopia

Correction: Meeting Community Health Worker Needs for Maternal Health Care Service Delivery Using Appropriate Mobile Technologies in Ethiopia

Establishing a framework for a physician assistant/bioethics dual degree program.

: Numerous medical schools currently offer a master of arts (MA) in bioethics dual degree for physicians. A degree in bioethics enhances the care physicians provide to patients and prepares physicians to serve on ethics committees and consult services. Additionally, they may work on institutional and public policy issues related to ethics. Several physician assistant (PA) programs currently offer a master of public health (MPH) dual degree for PAs. A degree in public health prepares PAs for leadership roles in meeting community health needs. With the success of PA/MPH dual degree programs, we argue here that a PA/bioethics dual degree would be another opportunity to advance the PA profession and consider how such a program might be implemented. The article includes the individual perspectives of the authors, one of whom completed a graduate-level certificate in bioethics concurrently with his 2-year PA program, while the other served as a bioethics program director.

Meeting Community Health Worker Needs for Maternal Health Care Service Delivery Using Appropriate Mobile Technologies in Ethiopia

BackgroundMobile health applications are complex interventions that essentially require changes to the behavior of health care professionals who will use them and changes to systems or processes in delivery of care. Our aim has been to meet the technical needs of Health Extension Workers (HEWs) and midwives for maternal health using appropriate mobile technologies tools.MethodsWe have developed and evaluated a set of appropriate smartphone health applications using open source components, including a local language adapted data collection tool, health worker and manager user-friendly dashboard analytics and maternal-newborn protocols. This is an eighteen month follow-up of an ongoing observational research study in the northern of Ethiopia involving two districts, twenty HEWs, and twelve midwives.ResultsMost health workers rapidly learned how to use and became comfortable with the touch screen devices so only limited technical support was needed. Unrestricted use of smartphones generated a strong sense of ownership and empowerment among the health workers. Ownership of the phones was a strong motivator for the health workers, who recognised the value and usefulness of the devices, so took care to look after them. A low level of smartphones breakage (8.3%,3 from 36) and loss (2.7%) were reported. Each health worker made an average of 160 mins of voice calls and downloaded 27Mb of data per month, however, we found very low usage of short message service (less than 3 per month).ConclusionsAlthough it is too early to show a direct link between mobile technologies and health outcomes, mobile technologies allow health managers to more quickly and reliably have access to data which can help identify where there issues in the service delivery. Achieving a strong sense of ownership and empowerment among health workers is a prerequisite for a successful introduction of any mobile health program.

Let's Get Healthy! Health Awareness Through Public Participation in an Education and Research Exhibit

Health information technology (HIT) offers a resource for public empowerment through tailored information. Use interactive community health events to improve awareness of chronic disease risk factors while collecting data to improve health. Let's Get Healthy! is an education and research program in which participants visit interactive research stations to learn about their own health (diet, body composition, blood chemistry). HIT enables computerized data collection that presents participants with immediate results and tailored educational feedback. An anonymous wristband number links collected data in a population database. RESULTS AND LESSONS LEARNED: Communities tailor events to meet community health needs with volunteers trained to conduct research. Participants experience being a research participant and contribute to an anonymous population database for both traditional research purposes and open-source community use. By integrating HIT with community involvement, health fairs become an interactive method for engaging communities in research and raising health awareness.

Micronutrient Deficiency Conditions: Global Health Issues

Micronutrient deficiency conditions are widespread among 2 billion people in developing and in developed countries. These are silent epidemics of vitamin and mineral deficiencies affecting people of all genders and ages, as well as certain risk groups. They not only cause specific diseases, but they act as exacerbating factors in infectious and chronic diseases, greatly impacting morbidity, mortality, and quality of life. Deficiencies in some groups of people at special risk require supplementation, but the most effective way to meet community health needs safely is by population based approaches involving food fortification. These complementary methods, along with food security, education, and monitoring, are challenges for public health and for clinical medicine. Micronutrient deficiency conditions relate to many chronic diseases, such as osteoporosis osteomalacia, thyroid deficiency colorectal cancer and cardiovascular diseases. Fortification has a nearly century long record of success and safety, proven effective for prevention of specific diseases, including birth defects. They increase the severity of infectious diseases, such as measles, HIV/AIDS and tuberculosis. Understanding the pathophysiology and epidemiology of micronutrient deficiencies, and implementing successful methods of prevention, both play a key part in the New Public Health as discussed in this section, citing the examples of folic acid, vitamin B12, and vitamin D.