Mid-sized Community Research Articles

Shifting Hearts and Minds: Practical Communications Strategies for Addressing Homelessness in Mid-Size Cities

The visibility of homelessness is increasing in mid-size cities, putting municipalities under mounting pressure to address this complex issue. Unfortunately, community sentiment and responses to homelessness are often informed by misinformation and divisive narratives. Communication strategies, therefore, play a key role in educating audiences, highlighting shared values across the political spectrum, and advancing human rights-based and sustainable solutions to homelessness. In this article, we offer strategies for educating, uniting, and mobilizing different stakeholders around human rights-based approaches to homelessness. We discuss how to segment, target, and reach different audiences with values-based and research-backed messaging, particularly through a layered approach. We share practical tools on how, when, and where to most effectively deploy content to maximize its reach. We also discuss best practices for communicating with any audience on the critical homelessness and human rights issues facing mid-sized communities today. These strategies and best practices will allow you to communicate with purpose, make the best use of resources, shift hearts and minds, and ultimately advance your goal of promoting human rights-based and sustainable solutions to homelessness in your community.

Approach to Congestive Heart Failure Readmission Reduction in a Community-Based Setting: A Field Report

This article examines how a midsize community hospital designed a readmission reduction project with the goal of decreasing readmissions for patients with a primary diagnosis of congestive heart failure. Multicomponent interventions were implemented for patient enrollment in this quality improvement initiative with clear inclusion criteria. The study concluded that a structured transition of care plan with remote patient monitoring, together with well-defined criteria for the initiation of rescue medications, has the potential for decreasing avoidable hospital readmissions.

Amplifying Youth Voices Using Digital Technology: A Case Study in Collaborative Research With Youth Service Organizations

This paper presents three participatory methods informed by design techniques for engaging youth and youth services providers in research activities online. We detail two data collection methods: 1) a priming activity completed before a focus group to prompt reflection before direct interaction with the research team; and 2) a focus group activity imagining future organizational goals. We also share our technique for collaboratively analyzing preliminary research findings with a focus group activity. We developed these methods as a part of a larger research project examining how teens and those who provide services to teens through community programs conceptualized success in their experiences, sense of community, and program implementation. This paper discusses work with five organizations in a mid-size community in the midwestern United States during the COVID-19 pandemic (July 2021–February 2022). We aimed to amplify the voices and perspectives of teens in both research and the organizations they engaged in, bringing their participation to our data collection and analysis and to the adults and decision-makers of community organizations. We wanted to understand how youth or teens, defined as 13–19 years old, describe successful experiences in these out-of-school settings, how adults define success, and to identify connections and differences between these two perspectives. This paper details the techniques we developed and tested, shares examples from our research, and discusses the impacts and implications of these methods for future participatory work. We contribute evidence for the value of drawing on design methods for participatory methods, articulate benefits and considerations for intentionally doing so online, and share techniques that emphasize voice in both research and organizational partners’ program development and management.

The places we'll go: How have rural residents changed over time?

An increasingly key consideration in Canadian immigration policy is rural settlement patterns. As Canada’s largest census metropolitan areas (CMAs) continue to see increases in overall population, smaller and mid-sized communities face greater challenges in attracting and retaining newcomers as a means of economic and population improvements. As such, it is becoming increasingly important to look at the characteristics of individuals who opt for rural settlement in order to improve the outcomes of future attraction initiatives. While a substantial body of literature looks at the movement of immigrants and native-born Canadians across the country, far fewer look at the characteristics that positively predict rural settlement. This study helps to close the knowledge gap by investigating these characteristics and how they change over a 25-year period, using two identical logistic regression models and a pooled cross-sectional model based on the 1991 and 2016 Canadian Census. Overall, age, lower levels of education and income, as well as non-immigrant and non-visible minority statuses lead to higher propensities for rural living. However, the general trend is a move away from rural settlement in favour of larger cities.

Impact of a systematic framework for anticipatory compounding on medication waste reduction in a mid-size community hospital.

In current hospital pharmacy practice, the need to compound medications ahead of patient orders often results in an increase in medication waste. The purpose of this study was to implement a strategic approach for anticipatory sterile compounding and evaluate its effect on the reduction of expired medication waste. This was a pre-/post-intervention quasi-experimental study with 3 weeks of data collection for both arms and a 1-week washout period to implement process changes. A par log was placed on the medication storage refrigerator used for anticipatory compounding, with minimum and maximum levels determined by the demand-forecasting model. The primary outcome was the percentage of observations associated with waste. The secondary outcomes were the overall percentage of sterile compounding spending attributable to waste, median wasted dollars per sterile compounded product, and median dollars spent per sterile product compounded as anticipatory stock. Descriptive statistics were calculated using Minitab version 20, with the α level set to 0.05. A total of 4,619 observations were included in the analysis: 2,433 in the preintervention group and 2,186 in the postintervention group. Despite the median price being higher in the postintervention group than in the preintervention group, both the primary and secondary outcomes indicated that waste was reduced following the intervention. Overall, implementation of the framework reduced sterile products waste at our institution. More research is needed to evaluate the effects of this framework at institutions of different sizes and with different patient populations. Further research on probabilistic models for sterile compounded products is also needed.

Postoperative opioid-induced respiratory depression or oversedation requiring naloxone treatment in a community hospital: a case series

Background Postoperative opioid-induced respiratory depression and oversedation can lead to fatal events and increase perioperative mortality. In reports from major academic centers, naloxone administration has been used as a proxy for severe opioid overdose. Herein, we studied the incidence, clinical characteristics, and outcomes of postoperative naloxone use in a mid-size community hospital. Methods This was a retrospective review of adult patients who received naloxone within 48 postoperative hours between July 9, 2017, and May 31, 2022. Results During the study timeframe, a total of 23,362 surgical procedures were performed and a total of 19 patients received naloxone (8 in the recovery room, 11 on hospital wards), with an incidence of 8.1 [95% confidence interval 4.9–12.7] per 10,000 anesthetics. In 12 cases (63%), naloxone was indicated for oversedation, and in 7 cases (37%), for opioid-induced respiratory depression. All patients received naloxone within the first 24 postoperative hours. While all patients survived the opioid-related adverse event, 2 patients were intubated, 1 developed stress-induced cardiomyopathy, and 5 required intensive care unit admission. Conclusion The rate of early postoperative opioid-induced respiratory depression or oversedation in our community hospital was low; however, these patients often require a substantial escalation of medical management.

Impact of school operating scenarios on COVID-19 transmission under vaccination in the U.S.: an agent-based simulation model

At the height of the COVID-19 pandemic, K-12 schools struggled to safely operate under the fast-changing pandemic situation. However, little is known about the impact of different school operating scenarios considering the ongoing efforts of vaccination. In this study, we deployed an agent-based simulation model to mimic disease transmission in a mid-sized community consisting of 10,000 households. A total of eight school operating scenarios were simulated, in decreasing order of restrictiveness regarding COVID-19 mitigation measures. When masks were worn at school, work, and community environments, increasing in-person education from 50% to 100% would result in only 1% increase in cumulative infections. When there were no masks nor contact tracing while schools were 100% in person, the cumulative infection increased by 86% compared to the scenario when both masking and contact tracing were in place. In the sensitivity analysis for vaccination efficacy, we found that higher vaccination efficacy was essential in reducing overall infections. Our findings showed that full in-person education was safe, especially when contact tracing, masking, and widespread vaccination were in place. If no masking nor contact tracing was practiced, the transmission would rose dramatically but eventually slow down due to herd immunity.

To Dodd-Frank and Back: Regulatory Burden and the Economic Growth, Regulatory Relief, and Consumer Protection Act

We measure the regulatory burden Dodd-Frank imposes and the regulatory relief the Economic Growth, Regulatory Relief, and Consumer Protection Act (EGRRCPA) affords. We analyze burden and relief on various measures of bank performance. And we emphasize community-bank holding companies (BHC). Based on data in the Consolidated Financial Statements for Holding Companies (FR-Y9C) reports from 1991 to 2019 and a model of a price-taking intermediary, we parsimoniously specify each performance measure as a function of BHC-specific observable variables, BHC-specific unobservable heterogeneity, Dodd-Frank regulation, and EGRRCPA relief. On balance, we find Dodd-Frank reduces loans per assets and loans per employee, while it increases non-interest expenses. Meanwhile, EGRRCPA provides some regulatory relief. For example, for mid-sized community BHCs, the implementation of EGRRCPA increases return on assets by roughly 23 basis points annually. JEL Codes: G21, G28

Discrimination Experienced by Immigrants, Racialized Individuals, and Indigenous Peoples in Small- and Mid-Sized Communities in Southwestern Ontario.

We investigate discrimination experiences of (1) immigrants and racialized individuals, (2) Indigenous peoples, and (3) comparison White non-immigrants in nine regions of Southwestern Ontario containing small- and mid-sized communities. For each region, representative samples of the three groups were recruited to complete online surveys. In most regions, over 80 percent of Indigenous peoples reported experiencing discrimination in the past 3 years, and in more than half of the regions, over 60 percent of immigrants and racialized individuals did so. Indigenous peoples, immigrants and racialized individuals were most likely to experience discrimination in employment settings and in a variety of public settings, and were most likely to attribute this discrimination to racial and ethnocultural factors, and for Indigenous peoples also their Indigenous identity. Immigrants and racialized individuals who had experienced discrimination generally reported a lower sense of belonging and welcome in their communities. This association was weaker for Indigenous peoples. The findings provide new insight into discrimination experienced by Indigenous peoples, immigrants and racialized individuals in small and mid-sized Canadian communities, and are critical to creating and implementing effective anti-racism and anti-discrimination strategies.

Themed section introduction: Emerging research on racial/ethnic inequality in Canada.

Themed section introduction: Emerging research on racial/ethnic inequality in Canada.

Using PSI-90 Scores to Improve Patient Safety and Quality Ratings

The Agency for Healthcare Research and Quality (AHRQ) developed patient safety indicators (PSIs) to help hospitals identify potentially preventable complications after surgeries and procedures.1 Despite their use by federal programs to assess quality of care, there is no consensus on their accuracy as a marker of quality.2 This article examines how a midsize community hospital used PSI-90 scores to develop targeted interventions that resulted in improved patient safety and quality ratings.

Interdisciplinary Approach to Reducing Healthcare Associated Infections Amid COVID-19 Pandemic

BackgroundThe COVID-19 pandemic has challenged acute-care hospitals (ACH) in numerous ways including increases in healthcare associated infections (HAI). The Centers for Disease Control and Prevention (CDC) 2020 Annual National and State HAI Progress Report denotes a 24% increase in central line associated bloodstream infections (CLABSI) between 2019 and 2020 with a 50% increase in the intensive care units (ICU) and minimal change in catheter associated urinary tract infections (CAUTI).MethodsAn interdisciplinary Healthcare Acquired Conditions (IHAC) team was implemented in a mid-size community hospital in Wisconsin to focus on the increase of HAI's during the pandemic. The IHAC team began meeting in November 2020 to discuss HAI events in real time and identify opportunities for improvement. The IHAC team was co-led by Nursing and Quality with standing membership including Infection Prevention, Risk, Safety, and Site Leadership. After HAI identification, IP communicates HAI event to the attribution unit. The unit reviews the medical record to complete a standardized tool and shares findings at the IHAC meeting. During the IHAC review, the team identifies improvement opportunities and assigns accountability with site leadership support.ResultsSince the IHAC team was established, there was an ongoing decline in HAIs. The following events were reported from January to December 2020: five (5) ICU CLABSI with a standardized infection ratio (SIR) 2.770 and two (2) non-ICU CLABSI SIR 0.667; two (2) ICU CAUTI SIR 1.002 and eight (8) non-ICU CAUTI SIR 1.864. After implementation of the IHAC team, there was a decrease in CAUTI and CLABSI events in January to September 2021: one (1) ICU CLABSI SIR 0.609 and one (1) non-ICU CLABSI SIR 0.318; one (1) ICU CAUTI SIR 0.573 and two (2) non-ICU CAUTI SIR 0.455.ConclusionsHAI reduction is achievable with an interdisciplinary approach discussing and identifying opportunities for improvement with the support of senior leadership.

Assessing the contribution of immigrants to Canada’s nursing and health care support occupations: a multi-scalar analysis

BackgroundThe World Health Organization adopted the Global Strategy on Human Resources for Health Workforce 2030 in May 2016. It sets specific milestones for improving health workforce planning in member countries, such as developing a health workforce registry by 2020 and ensuring workforce self-sufficiency by halving dependency on foreign-trained health professionals. Canada falls short in achieving these milestones due to the absence of such a registry and a poor understanding of immigrants in the health workforce, particularly nursing and healthcare support occupations. This paper provides a multiscale (Canada, Ontario, and Ontario’s Local Health Integration Networks) overview of immigrant participation in nursing and health care support occupations, discusses associated enumeration challenges, and the implications for health workforce planning focusing on immigrants.MethodsDescriptive data analysis was performed on Canadian Institute for Health Information dataset for 2010 to 2020, and 2016 Canadian Census and other relevant data sources.ResultsThe distribution of nurses in Canada, Ontario, and Ontario’s Local Health Integration Networks reveal a growth in Nurse Practitioners and Registered/Licensed Practical Nurses, and contraction in the share of Registered Nurses. Immigrant entry into the profession was primarily through the practical nurse cadre. Mid-sized communities registered the highest growth in the share of internationally educated nurses. Data also pointed towards the underutilization of immigrants in regulated nursing and health occupations.ConclusionImmigrants comprise an important share of Canada’s nursing and health care support workforce. Immigrant pathways for entering nursing occupations are complex and difficult to accurately enumerate. This paper recommends the creation of an integrated health workforce dataset, including information about immigrant health workers, for both effective national workforce planning and for assessing Canada’s role in global health workforce distribution and utilization.

Individual and contextual factors associated with bicyclist injury severity in traffic incidents between bicyclists and motorists in Chile

Bicyclists are vulnerable road users who risk incurring severe injuries from traffic incidents involving motorists. However, the prevalence of severe bicycle injuries varies across countries and is not well-documented in Latin American countries. Studies from developed countries outside of Latin America have shown that individual and contextual factors are associated with severe injuries incurred by bicyclists in road traffic incidents with motorists, but it is not clear whether these factors are the same as those incurred by Latin American bicyclists. Moreover, most studies on bicyclist-motorist traffic incidents have treated injury severity as a binary variable for analysis although injuries range widely in severity. The aims of this study were to determine the prevalence of bicycle injuries from incidents between motorists and bicyclists in Chile and examine the associations between individual and contextual factors and bicyclist injury severity, treated as an ordinal outcome variable, in these incidents. Data on road traffic incidents between bicyclists and motorists from the 2016 Traffic Accident of Bicycle Riders and Consequences database of the Chilean Transport Ministry were analysed. Multilevel mixed-effects ordinal regression models were used to examine associations. In total, 81.2 % of 4093 traffic incidents between bicyclists and motorists resulted in nonfatal injuries to bicyclists and another 2.3 % resulted in fatalities. Most incidents involved collisions (84.3 %), and most were due to a motorist being distracted while driving (50.4 %). Severe bicyclist injuries were more likely when the incident involved a stationary cyclist who was struck, a collision between a moving bicycle and a moving motor vehicle, or an overturning motor vehicle striking a bicyclist (p < 0.001). Other factors included the motorist driving under the influence of alcohol (p = 0.05), the incident taking place in a mid-size community (p = 0.04), the incident occurring between 7:00 pm and 4:59 am (p < 0.01), and the injured bicyclist being under 18 years or 45+ years of age (p < 0.05). These findings suggest the need for educational programs that promote safe driving behaviour in the presence of bicyclists, better enforcement of laws and higher penalties for distracted or drunk driving, and provision of high-quality exclusive bicyclist infrastructure to address the vulnerability of the youngest and oldest bicyclists on shared roads, particularly in mid-size communities, and to provide better lighting on bikeways for evening bicycling, to reduce the high incidence of severe bicyclist injuries in motorist-bicyclist incidents.

Experiences and Perspectives on Adopting New Practices for Social Needs-targeted Care in Safety-net Settings: A Qualitative Case Series Study.

IntroductionClinical settings are being encouraged to identify and address patients’ social needs within the clinic or through partner organizations. The purpose of this qualitative study was to describe the current practice of social needs-targeted care in 3 Texas safety net clinics, and facilitators and barriers to adopting new social needs-targeted care tools and practices.MethodsInterviews were conducted with staff at 3 safety net clinics serving small and mid-sized communities. Analysis focused on perspectives and decisions around adopting new tools or practices related to social needs-targeted care, including standardized screening tools and community resource referral platforms.ResultsNine staff across 3 organizations were interviewed. Two organizations were currently using a standard social needs screening tool in their routine practice, and a third was considering doing so. One organization had adopted a community resource referral platform in partnership with a large community collaboration. Three case studies illustrate a range of facilitators, barriers, perceived benefits, and drawbacks influencing social needs-targeted practices. Benefits of systematic data collection on social needs included the generation of data for community action. Drawbacks include concerns about data privacy. Community resource referral platforms were seen as valuable for creating accountability, but required an influential community partner and adequate community resources. Concerns about disempowering clients and blurring roles were voiced, and potential to increase provider job satisfaction was identified.ConclusionsBenefits and drawbacks of adopting new tools and practices related to social needs-targeted care are strongly influenced by the community context. For the adoption of community resource referral platforms, the outer setting is particularly relevant; adoption readiness is best assessed at the community or regional level rather than the clinic system level. While screening tools are much easier than referral platforms for clinics to adopt, the ability to address identified needs remains heavily based on the outer setting.

It Requires a Community to Raise a Deaf Adult: A Comparative Study

It has often been said, “It takes a village to raise a child”; likewise for deaf children born into hearing families, this village model provides the support necessary for optimal developmental outcomes for the child. Here a mixed method design was used to understand the outcomes for deaf adults who grew up a mid-size community with fragmented services in order to better understand what worked and what had not worked for these individuals. Results from a survey and follow up interviews identified two groups of individuals, those who stayed in the community having access only to the local resources and those who left the community finding more resources. In general, those who stayed described themselves as hard of hearing and used a mixture of sign and spoken language while those who left identified as Deaf and reported finding a Deaf community that provided them role models, aspirational capital, and a Deaf identity. Results are discussed using the frame of integrating support for families, effective schooling, and transition services. Recommendations are made to support the creation of such villages for deaf children in areas that may not have sufficient resources.

“They’re Really Family!”: Discursive Dynamics of Municipal Twinnings Between Louisiana and Acadian Communities of the Maritime Provinces

Whether considered as a form of “diplomacy by cities,” as a strategy for small and mid-sized communities to assert their role amidst globalization, or as a means of territorial cooperation, twinnings between municipalities of different countries represent a common and oft celebrated facet of contemporary transnationalization. Sister cities in Louisiana and Canada’s Maritime Provinces play an important part in the transnational networks among populations of the Acadian diaspora, a people “scattered to the wind” in the eighteenth century after mass deportation by British authorities. There are currently 12 such twinnings, and partnerships with the French-speaking world figure prominently in external subnational relations across the Maritimes, especially in New Brunswick. This article examines emerging discourses of diasporic Acadian identity through municipal twinnings between Louisiana and l’Acadie des Maritimes. After a general profile of twinnings in the Maritimes, I analyze the evolution of language used in sister-city agreements before offering examples of sister cities’ unique contribution to a sense of diasporic belonging.

A model for investigating the impact of owned social media content on commercial performance and its application in large and mid-sized online communities

ABSTRACT Social media communities are commonly used as marketing tools to reach millions of users. Through two studies, we investigate how owned social media content is associated with commercial performance and moderated by community size. We find that commercial performance is positively associated with posts showcasing the superior value of a product or brand and with posts that have an intention to sell. In addition, in large online communities, posts intended to create social interactions among marketers and users are not associated with commercial performance. However, in mid-sized communities, posts with the same intentions increase commercial performance. We theorise that the presence of internet trolls and a lower sense of group loyalty may explain the absence of these associations in large online communities. Finally, we identify four dimensions of content that were fairly consistent across studies. We customise these content dimensions according to each of the industries studied for marketers’ use.

Citizen Characteristics, Neighbourhood Conditions, and Prior Contacts with the Police: A Comparative Study of Public Satisfaction with the Police

This study takes a comparative approach to examine public satisfaction with the police, focusing on three theoretical models: the demographic model, the neighbourhood conditions model, and the prior contacts with the police model. Using survey data collected from two mid-sized communities in the U.S. and Canada, this study analyzes the similarities and differences in the factors affecting satisfaction with the police with both statistical methods and random forests analysis. The statistical results suggest a great amount of similarity in the effects of theoretically relevant factors across the two samples. The random forests analysis further points to the consistent importance of age, quality of life, and education in predicting public satisfaction. In addition, both analyses find that the effects of age and quality of life are stronger for the sample in the U.S. than those for the sample in Canada. This study suggests that police departments in these jurisdictions could effectively improve satisfaction with the police by addressing quality of life issues in their communities and improving their relationship with younger citizens and citizens with lower levels of education through better interactions.

Occupational Credentials for Jobs in the Subbaccalaureate Economy: The Case of the Emerging Energy Sector in Ohio

Using data on a mid-sized community college in northeast Ohio as a case study, we examine patterns of enrollment in petroleum technology credential programs and labor market returns to those credentials. The enrollment analysis yields mixed results. Strong industry conditions represented by an increase in oil prices is associated with a decline in program enrollment; however, higher wages for petroleum workers is associated with increased program enrollment. Earning analyses were unambiguous: Obtaining a certificate or an associate’s degree was associated with outsized quarterly earnings returns of $2,900 and $5,500, respectively. This study suggests that partnerships that align subbaccalaureate postsecondary education to the needs of local labor markets may result in occupational credentials with substantially larger returns than those observed in the literature.