Participatory Action Research Approach Research Articles

Exploring what works well and less well in a community-based drop-in hub providing health and wellbeing services for people experiencing homelessness: a participatory action evaluation of service coordination

Abstract Background People experiencing homelessness often face obstacles accessing health and social care support. Challenges are further exacerbated when support provision for multiple unmet needs are not integrated or coordinated. To overcome these challenges, there has been growing attention on integrating and co-locating health and wellbeing services for people experiencing homelessness. In an urban area of North East England, a long-standing Hub or ‘drop-in centre’ offers a range of health and wellbeing support by bringing together the different health and care system agencies in one space. However, little is known about the perspectives of providers on what works well and less well in how the different services are coordinated. Methods Using a participatory action research approach, a qualitative service evaluation was undertaken between June and September 2023. Fourteen interviews were conducted with providers who work in a paid or voluntary capacity operating some of their service offerings or support in the Hub. Interview transcripts were analysed using inductive reflexive thematic analysis. Results Three themes were evident from the evaluation: 1) location and space matter, 2) co-location and relationships make a difference, and 3) service consistency and flexibility are paramount. Conclusion Co-locating support to cover the breadth of health and care needs has the potential to increase engagement and access for people experiencing homelessness, and to enhance trust with service users and between agencies. This model provides a unique example of co-location and integration of support, particularly with it being operated by a community housing organisation.

Mengorganisir Sampah yang Tercemar di TPS Masyarakat Dusun Karanglangon Desa Leran Wetan Kecamatan Palang Kabupaten Tuban

Waste is leftover material that is considered to have no economic value, but its existence cannot be avoided in people's social life. In Karanglangon Hamlet, the increase in population that occurs every year increases the volume of waste produced. As the population increases, household waste production and other activities also increase, thereby exacerbating waste management problems in the region. If not managed properly, the increasing amount of waste can have various negative impacts, both on public health and the surrounding environment, such as air, land and water pollution. This problem demands more attention from various parties to find appropriate and sustainable solutions. This research aims to identify in more depth the problems related to waste management at the Dusun Karanglangon TPS using the PAR (Participatory Action Research) approach method. The research results revealed that the condition of the waste at the TPS had a significant negative impact on the surrounding environment. The main causes are limited facilities, minimal budgets, and inadequate waste management standards, resulting in the accumulation of waste and increasingly severe environmental pollution.

Research on Education for Sustainable Development with Design-Based Research by Employing Industry 4.0 Technologies for the Issue of Single-Use Plastic Waste in Taiwan

The social impacts of prevailing circular economy (CE) strategies remain under-researched despite the considerable attention that CE has received from scholars and in industry. Existing CE indicators primarily focus on business models from a decision-making standpoint, overlooking consumer engagement and alternative solutions. Boasting one of the highest recycling rates globally, Taiwan faces challenges in optimizing collected resources. This study delves into recycling plastic waste by integrating consumer behavior within CE strategies, leveraging open-source resources and additive manufacturing technologies to align with the United Nations Agenda 2030, particularly Sustainable Development Goals (SDGs) 4 (Quality Education), 12 (Responsible Consumption and Production), and 13 (Climate Action). These resources facilitate the transformation of plastic waste into reusable materials. Employing an exploratory and participatory action research approach, this research uses the Precious Plastic Universe (PPU) database to identify potential resources from post-consumer polymer waste. Subsequently, it explores tools for converting collected waste into usable polymers. Lastly, the study investigates integrating collected polymer waste into student design projects to enhance creativity and problem-solving skills for sustainable development, employing additive manufacturing tools at the National Taiwan Normal University Department of Design. Thematic analysis of the data revealed several recurring patterns, including the role of consumer behavior in plastic waste generation, the development of creativity and problem-solving skills among students, and the challenges of working with recycled materials. These themes were observed in quantitative data (collected single-use polymers) and qualitative insights from student observations and interviews. Through thematic analysis, the study highlights key factors contributing to successful CE integration, providing a model for future educational and industrial applications of sustainable design.

Research priorities: Establishing discipline-based education research in prosthetics and orthotics.

Education research, as a field of study, is relatively new to the health professions. Research and scholarship in prosthetics and orthotics education is limited, and the priority areas and needs of individuals interested in pursuing this area of research and scholarship are unknown. The objectives of this study were to collaboratively identify the areas in which education research in prosthetics and orthotics is needed, to prioritize these areas, and to evaluate the resources needed to support those interested in pursuing education research. Mixed methods. The researchers used a participatory action research approach. Focus group sessions were held at the 2022 International Society for Prosthetics and Orthotics (ISPO) Global Educators Meeting. Findings from the focus groups informed creation of a survey that was distributed internationally. The results of this survey were presented to attendees at the 2023 ISPO World Congress for review and ranking. Findings from focus group discussions were used to create a 20-item survey. High priority categories included providing feedback to students, program evaluation, and clinical education and internship. Protected time and funding, faculty development, and program resources were identified as items needed to support faculty in pursuing education research. At the ISPO World Congress, participants highly rated the categories of academic v. clinical practice, program resources, and program evaluation. Many categories were identified as priorities for orthotic and prosthetic education research, and ways to support faculty pursuing this work were highlighted. This study identified opportunities for education researchers to focus their efforts on directly impacting needs of education programs and the profession.

Zooming In and Out of Programming: Developing an Approach to Trauma-and Violence-Informed Physical Activity “Post-Pandemic”

Researchers have found that physical activity is an effective health promotion tool due to its positive effect on wellbeing, however, despite the overwhelming evidence on the benefits of physical activity, many structural and systemic inequities exist that affect access and uptake particularly for women. These barriers have been exacerbated over the last few years as conditions surrounding the COVID-19 pandemic has made engagement in physical activity even more difficult for equity-deserving populations. Community organizations have reported an increase in gender-based violence and a strain on support services. In this qualitative research study, we present findings that demonstrated how COVID-19 complicated the delivery of in-person programs for equity-deserving populations. Using a feminist participatory action research approach, community-specific barriers to physical activity from the perspectives of individuals who deliver physical activity programming and social services to self-identified women were generated in three themes using thematic analysis: 1) Increased Need, Decreased Services; 2) Online Service Provision was Not Effective for Clients or Providers; 3) Physical Activity was Not Deemed an “Essential Service”-Transitioning from Survival Mode to a New Normal. Taken together, findings underlined the importance of effective and sustainable resources and strategies to improve access for women to engage in physical activity programs.

Building Connections: The Impact of Digital Storytelling on Communication and Leadership Skills Among Disabled Young Adults

Digital storytelling has been applied in research in varied contexts and with varied purposes. Implicit in the process of digital storytelling is the potential to develop and/or enhance a range of individual skills (e.g., multimedia, literacy, communication, etc.). However, further research is needed to gain a deeper understanding of the potential impact of digital storytelling on skill enhancement for disabled youth. This paper provides an overview of Phase 1 of the study “My life. My story: The Youth Digital Storytelling Project” that utilized elements of a community-based participatory action research approach to host a peer-facilitated digital storytelling workshop for young adults with developmental disabilities aimed at capturing and sharing their lived experiences with, knowledge of, and perspectives on significant life-stage transitions in the areas of education, employment, or living. The results from the pre- and post-workshop questionnaires suggest that the participants improved skills in media literacy, communication, and leadership. Additionally, the participants highlighted the importance of considering the delivery format, fostering connections, and enhancing self-confidence in the development of the workshop’s design and delivery. This research adds to the extant literature demonstrating the potential of digital storytelling as a pedagogical tool, offering implications for the design and implementation of online workshops for disabled youth.

Codesigning a Digital Type 2 Diabetes Risk Communication Tool in Singapore: Qualitative Participatory Action Research Approach.

Diabetes is a serious public health concern worldwide. Despite public health efforts encouraging early screening and improving knowledge of effective interventions for those at increased risk of type 2 diabetes (T2D), the incorporation of preventative behaviors into an individual's daily life remains suboptimal. Successfully and accurately increasing risk perception has been demonstrated to increase behavioral intention. The study aims to codesign a T2D risk communication tool by engaging public participants to (1) identify key characteristics that contribute to an effective risk communication tool and (2) test and iterate to develop a culturally sensitive and meaningful risk communication tool that can motivate T2D preventative behaviors. We adopted a novel methodology, "Patient and Public Involvement (PPI) Hawkers," where we approached patrons at hawker centers and public eateries frequented by all local residents to evaluate and test 3 prototypes for the tool. The three prototypes were (1) "Diabetes Onset"-estimated age of diabetes onset of T2D based on one's risk factors, (2) "Relative Risk"-the relative risk of T2D is presented in a 1-10 scale indicating where one's risk score lie in relation to others, and (3) "Metabolic Age"-the median age of the risk category based on one's risk factors, presented to be compared against their chronological age. We gathered reactions and feedback through rapid testing and iteration to understand which risk result presentation would be received the best. All the collected data were revisited and analyzed using an inductive thematic analysis to identify the key characteristics contributing to an effective risk communication tool. We engaged with 112 participants (female: n=59, 56%) across 6 hawker centers. The key characteristics that were important to participants emerged in four main themes: (1) appeal and user experience, in terms of format and readability; (2) trust and validity of the institution providing the tool and the accuracy of the risk result; (3) threat appraisal: salience of risk information, which influenced their risk perception; and (4) coping appraisal: facilitators for behavior change, which impacted their intention for implementing T2D preventative behaviors. The predictive nature of the prototype entitled "Diabetes Onset" was poorly received and removed after the first iteration. The Relative Risk prototype was valued for being straightforward but feared to be boring. The Metabolic Age prototype was anticipated to be more motivating for behavior change, but there were some concerns that the terminology may not be understood by everyone. Participants were divided on which of the 2 prototypes, "Metabolic Age" or "Relative Risk," they would favor adopting. Further testing is now required to determine which prototype will be more effective in motivating behavior change. This study's insights on the design process and valued characteristics of a risk communication tool will inform future development of such interventions.

Codesign of a Neurological Physiotherapy Student-Led Clinic With Students and Patients: An Exploratory Qualitative Study.

This study explores students' and patients' views of a UK physical therapy student-led clinic (SLC) for neurological rehabilitation and, using a codesign approach, it proposes an optimal design of a physical therapy SLC for neurological rehabilitation for patient participation and student learning. There is a paucity of literature examining experiences of neurological rehabilitation SLCs. Although research supports the utilization of codesign methodologies with patients and for curriculum development, there remains a gap regarding its application to SLCs in physical therapy for individuals with neurological conditions. Convenience sampling was used to recruit 4 patient and 4 student participants to take part in the study. This qualitative study employed exploratory codesign based on the participatory action research approach. Three online codesign workshops were facilitated by the research team. Thematic analysis of each workshop informed the outline for the next. Patients perceived that the SLC improved their overall well-being, and they highly valued being able to access rehabilitation. Students reported that they developed a range of clinical skills through participation in the SLC but would have liked a more in-depth orientation. The codesign process identified 5 key elements for the optimal design of the physical therapy neurological SLC: student support, continuity, supervision, peer-assisted learning, and orientation. Findings suggest that the SLC provides both a quality learning experience and a patient service, which is safe, effective, and sustainable. Future research should be undertaken with different stages of students and in different university settings. The codesign approach has been shown to be feasible for students and patients and could be used across other aspects of curriculum design. This novel study using codesign methodology provides initial findings of key elements to optimize SLCs in neurological physical therapy, to enhance student learning and patient experience.

Rekayasa Teknik Guludan sebagai Upaya Rehabilitasi Ekosistem Mangrove di Ekowisata Pantai Alam Serdang Bahari, Pantai Labu, Sumatera Utara

Abrasion at Alam Serdang Bahari Beach (ASB) is increasingly worrying, causing the reduction of mangrove forests on the coast. ASB Beach is located in Regemuk Village, Labu Beach. The ASB Mangrove Forest Farmers Group (KTHM) has made many efforts to continue to exist morally and materially to survive in the ecotourism industry and is trying to re-green the beaches to minimize the impact of abrasion. The results of a field assessment involving lecturers, village officials, and KTHM ASB obtained a roadmap for a sustainable development village with a solution to prevent prolonged abrasion using the simplest and most economical way through engineered bund techniques to protect mangrove plants and also act as a wave breaker. Implementing this PKM aims to make new efforts to plant mangrove trees as coastal abrasion protection. Implementing activities uses a participatory action research (PAR) approach. KTHM, as the partner, carried out the construction of the bund enclosure, and the PKM team was the drafter and supervisor. The results of the PKM implementation are three plots of bunds in the shape of a ship's bow as an effort to break the beach waves using the Rhizopora sp. propagules collected from mangrove seeds by KTHM ASB. This innovation is still early to assess because it requires ongoing monitoring. It is hoped that this effort will better protect newly planted mangrove plants from fierce waves and abrasion as a joint effort to prevent abrasion on ASB Beach.

Bridges between evidence on vaccination intervention and Ukrainian migrant community needs in Poland

Abstract Background Vaccination coverage in Ukrainian migrants’ (UM) children is lower compared to their Polish counterparts. We aimed to identify and adapt effective evidence-based interventions which would address health system barriers to HPV/MMR vaccination in this community. Methods With the help of the Participatory Action Research (PAR) approach, 4 researchers, 6 experts, 6 UM, 7 Ukrainian GPs and 3 teachers identified and discussed transferability of promising HPV/MMR vaccination interventions and their adaptation from the Polish and contextual perspective. The Population-Intervention-Environment-Transfer Model of Transferability (PIET-T) model was used to accompany the steps for determining transferability. Results Three intervention elements were considered as capable for increasing HPV/MMR vaccination uptake: a health promoter, group educational sessions and an online provider training. Adaptations were needed to make them consistent with the contextual needs. The intervention was adapted to involve Ukrainian GPs delivering culturally sensitive education and a Ukrainian coordinator offering navigation support; barriers (lack of information/language barrier) were addressed. The education sessions for parents were taken into account as having potential to increase knowledge and facilitate making informed decisions regarding vaccination. The online education course was assessed as a strategy to possibly enhance GPs knowledge to let them make strong HPV/MMR vaccine recommendations to UMs. Conclusions Both, community-based PAR approach, and the PIET-T model, facilitated the assessment of intervention transferability and adaptation in terms of covering the individual context, pattern and needs of UMs community in Poland, to finally increase HPV/MMR vaccination uptake.

8.N. Scientific session: Transferability and adaptation of vaccination interventions: Learning from underserved communities

Abstract Removing barriers in the health system that make it difficult for cultural, religious or ethnic minorities to access vaccinations is an urgent concern in order to prevent infectious diseases in the future. Childhood vaccine uptake for MMR and HPV in most underserved communities is lower than in the general population. The project RIVER-EU (Reducing Inequalities in Vaccine uptake in the European region - Engaging Underserved communities) engages the migrant community in Greece, females with a Turkish or Moroccan migration background in the Netherlands, the Ukrainian minority in Poland and marginalized Roma communities in Slovakia to remove health system barriers to vaccination. Barriers include, e.g., lack of culturally and linguistically appropriate information, financial barriers, insufficient capacities, coordination and delivery of health care. Based on a Participatory Action Research (PAR) approach we selected and adapted potentially transferable evidence-based interventions in partnership with the communities. First, we pre-selected 6 useful interventions from a realist review on 36 effective vaccine uptake interventions. Second, we assessed them in depth for their transferability. Building a bridge between evidence on interventions and community needs is not an easy task: We involved various stakeholders in a longitudinal process under consideration of contextual conditions in the primary intervention context and the context of the respective underserved community. We co-created knowledge through 25 workshops and 39 interviews or focus groups for decision-making and determining need for adaptation of selected interventions. The aim of this workshop is to present the results of this co-creative process in each country. Special attention is payed to facilitators and barriers for transferability of evidence-based interventions from the perspective of underserved communities, and contextual commonalities and differences that lead to a specific intervention tailoring. This workshop will contribute to an improved understanding of how to consider contextual needs underserved communities have to remove health system barriers to vaccination on the one hand and suitable evidence on interventions to improve their situation on the other hand. The workshop will include five presentations of eight minutes and a questions and answers session to involve the audience. First, an introductory presentation on transferability of interventions for HPV and MMR vaccine uptake to underserved communities in specific contexts will be given. Then each country will present the intervention(s) to address health system barriers adapted to their context. Thereby, we will underline common key elements that have potential for transferability in all countries. After all presentations, we will discuss the need for context-based decision-making on evidence-based interventions and intervention tailoring to improve vaccine uptake for cultural, religious or ethnic minorities. Key messages • Improving vaccine uptake in underserved communities requires local solutions with tailored interventions. Trusted partnerships with various stakeholders are key to reducing health system barriers. • Participatory approaches to evidence-informed decision-making build bridges between evidence on interventions and needs of underserved communities to understand the transferability of interventions.

Pendampingan Penguasaan Aplikasi Website dan Sistem PPDB Online

The Islamic Education Foundation faced serious challenges in IT infrastructure, which led to a lack of access to information as well as a new student admission process that was still done manually. This condition not only hampers administrative efficiency, but also reduces the interest of prospective students to register. To overcome these problems, the development of an official website and online PPDB system is a strategic step that aims to increase transparency and accessibility of information. A Participatory Action Research (PAR) approach, which involves the active participation of the entire service team in problem identification to solution implementation, was used to ensure the success of the project. The results of the programme showed significant improvements in administrative efficiency. The developed website serves as an effective information platform, while the online new student database system speeds up and simplifies the registration process. Training for staff and students also improved their IT skills, which had a positive impact on social change within the organisation. The application of technology in this educational context proved crucial in improving service quality and operational efficiency, making this programme a model that can be adopted by other educational institutions facing similar challenges in the digital age.

Immigration‐related stress, depression, and positive parenting among undocumented Central American immigrant mothers

AbstractObjectiveThe purpose of the current study was to examine whether immigration‐related stress is associated with reduced positive parenting and whether this association is mediated by depressive symptoms in undocumented Central American immigrant mothers.BackgroundIn the context of “illegality,” parents can face myriad stressors related to their immigration status, which may lead to heightened emotions, including depressed mood. These experiences may affect family life, including the ways in which immigrant mothers parent their children.MethodThis study examined survey data generated in 2016–2017 by researchers using a community‐based participatory action research approach in partnership with Central American immigrant mothers residing in the Washington, DC, region. The sample for this study included 117 undocumented Central American immigrant mothers of children aged 3 to 11 years.ResultsControlling for age of child, mother's education, and relationship status, analyses revealed that immigration‐related stress was associated with heightened levels of depressive symptoms for mothers. However, mothers' symptoms of depression were not associated with positive parenting. Additionally, no association between immigration‐related stress and positive parenting was found.ConclusionsFindings suggest that mothers, although affected by immigration‐related stress in terms of their own mood symptoms, may deploy mechanisms such as parental self‐sacrifice to protect their children from anti‐immigrant harms.ImplicationsFindings hold implications for future research, including research approaches, and practice.

Implementation of a tailored multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for urinary tract infections in frail older adults (ImpresU) in four European countries: a process evaluation alongside a pragmatic cluster randomized controlled trial

BackgroundWe previously performed a pragmatic cluster randomized controlled trial (RCT) in general practices and older adult care organizations in Poland, the Netherlands, Norway, and Sweden. We found that a multifaceted antibiotic stewardship intervention (ASI) substantially reduced antibiotic use for suspected urinary tract infections (UTIs) in frail older adults compared with usual care. We aimed to evaluate the implementation process of the ASI to provide recommendations for clinical practice.MethodsWe conducted a process evaluation alongside the cluster RCT. The ASI consisted of a decision-tool and a toolbox, which were implemented using a participatory-action-research (PAR) approach with sessions for education and evaluation. We documented the implementation process of the intervention and administered a questionnaire to health care professionals (HCPs) from participating organizations in the intervention and usual care clusters. We evaluated the multiple components of the intervention and its implementation following a structured framework.ResultsThe questionnaire was completed by 254 HCPs from the 38 participating clusters. All components were largely delivered according to plan and evaluated as useful. The decision-tool and toolbox materials were reported to facilitate decision-making on UTIs. Regarding the PAR approach, educational sessions focusing on the distinction between UTIs and asymptomatic bacteriuria were held in all 19 intervention clusters. In 17 out of these 19 clusters, evaluation sessions took place, which were reported to help remind HCPs to implement the ASI. During both sessions, HCPs valued the reflection that took place and the resulting awareness of their behavior. It allowed them to explore implementation barriers and to tailor their local implementation process to overcome these. For example, HCPs organized extra educational sessions or revised local policies to incorporate the use of the decision-tool. Various HCPs took key roles in implementation. Staff changes and the COVID-19 pandemic were important contextual barriers.ConclusionsWe found each component of the multifaceted ASI and its implementation to have added value in the process to improve antibiotic prescribing for suspected UTIs in a heterogeneous older adult care setting. We recommend using a multifaceted, multidisciplinary approach that enables HCPs to reflect on their current practice and accordingly tailor local implementation.Trial registrationClinicalTrials.gov NCT03970356. Registered on May 31, 2019.

Austerity Infrastructure, Gentrification, and Spatial Violence: A Ceaseless Battle over Urban Space in Exarcheia Neighbourhood

AbstractIn this paper, we aim to understand how long‐term state neglect of public infrastructure coexists with a renewed emphasis on profit‐driven infrastructure development in urban contexts. We focus on Exarcheia, an Athens neighbourhood known for its radical character, where a lack of public infrastructure investment aligns with plans for new transport infrastructure and urban regeneration. Using a participatory action research approach and engaging in collective discussions with grassroots organisations opposing these plans, we argue that prolonged austerity following the 2008 economic crisis has redefined state‐funded public infrastructures, aligning them more closely with the speculative interests of real estate, commercial, and infrastructure capital. The interplay of austerity infrastructure, gentrification, and spatial violence manifests as a form of slow urbicide, paving the way for revanchist urban regeneration that prioritises the commercial exploitation of urban space at the expense of the historical, political, and cultural identities of affected neighbourhoods.

Community-based palliative care needs and barriers to access among cancer patients in rural north India: a Participatory action research

BackgroundThis paper aimed to explore the palliative care (PC) needs and barriers to access among cancer patients in a rural region of North India with a high cancer burden.MethodsA Participatory action research (PAR) approach was employed. Situational assessment, community sensitization workshops (CSWs) and door-to-door surveys were planned, conducted and developed over three PAR cycles. A parallel convergent mixed-methods approach was adopted wherein the quantitative data from door-to-door surveys and qualitative data from CSWs and investigator field notes were collected and analyzed to provide a comprehensive understanding of PC needs and barriers to access. Descriptive statistics and thematic analysis were used.ResultsA total of 27 CSWs involving 526 stakeholders were conducted. A total of 256 cancer patients were assessed for PC needs and symptom burden using the Supportive and Palliative Care Indicators (SPICT-4ALL) and the Edmonton Symptom Assessment System (ESAS) tool, respectively. Based on the SPICT assessment, all patients (n = 256) satisfied general and/or cancer-specific indicators for PC. The majority (56.6%) had ≥ one moderate-severe symptom, with the most common symptoms being tiredness, pain and loss of appetite. Analysis of qualitative findings generated three themes: unmet needs, burden of caregiving, and barriers and challenges. Cancer affected all domains of patients’ and their families’ lives, contributing to biopsychosocial suffering. Social stigma, discrimination, sympathizing attitudes and lack of emotional and material support contributed to psychosocial suffering among cancer patients and their caregivers. Lack of awareness, nearby healthcare facilities, transportation, essential medicines, trained manpower and education in PC, collusion, fear of social discrimination, faulty perceptions and misconceptions about cancer made access to PC difficult.ConclusionsThe study emphasize the need for and provide a roadmap for developing context-specific and culturally appropriate CBPC services to address the identified challenges and needs. The findings point towards education of CHWs in PC; improving community awareness about cancer, PC, government support schemes; ensuring an uninterrupted supply of essential medicines; and developing active linkages within the community and with NGOs to address the financial, transportation, educational, vocational and other social needs as some of the strategies to ensure holistic CBPC services.Trial registrationClinical Trial Registry of India (CTRI/2023/04/051357).

In-service teacher education in death education through participatory action research (PAR)

ABSTRACT Current teacher education neglects educational needs, such as death education. A participatory action research (PAR) approach based on the needs and interests of teachers was adopted. One private and two state schools at all levels of non-university education were involved. The objective was to understand a process of change in teaching facilitated by PAR in the context of a teaching innovation project in death education. The results are presented according to the PAR phases. Conclusions are that the training process reduced the gap between scientific knowledge and educational practice, and that specific death education competencies were developed alongside personal growth amongst teachers.

Living less safely through the pandemic in England for people with serious mental and physical health conditions: qualitative interviews with service users and carers of Black African, Caribbean, and South-Asian descent.

COVID-19 Ethnic Inequalities in Mental health and Multimorbidities (COVEIMM) is a mixed methods study to explore whether COVID-19 exacerbated ethnic health inequalities in adults with serious mental and physical health conditions. We analysed data from electronic health records for England and conducted interviews in Birmingham and Solihull, Manchester, and South London. Sites were selected because they were pilot sites for the Patient and Carer Race Equality Framework being introduced by NHS England to tackle race inequalities in mental health. Prior to the pandemic people in England with severe mental illnesses (SMIs) faced an 11-17-year reduction in life expectancy, mostly due to preventable, long-term, physical health conditions. During the pandemic there was a marked increase in deaths of those living with an SMI. This qualitative interview study aimed to understand the reasons underlying ethnic inequalities in mortality and service use during the COVID-19 pandemic for adult service users and carers of Black African, Black Caribbean, Indian, Pakistani, and Bangladeshi backgrounds living with serious multiple long-term mental and physical health conditions. We took a participatory action research approach and qualitative interviews undertaken by experts-by-experience and university researchers Participants were purposively sampled by ethnicity, diagnoses, and comorbidities across three geographically distinct sites in England. Transcriptions were coded inductively and deductively and analysed thematically. Findings indicated multiple points along primary and secondary health pathways for mental and physical health that have the potential to exacerbate the unjust gap in mortality that exists for Black and Asian people with SMIs. Issues such as timely access to care (face-to-face and remote), being treated in a culturally appropriate manner with empathy, dignity and respect, and being able to use services without experiencing undue force, racism or other forms of intersectional discrimination were important themes arising from interviews. These poor experiences create systemic and enduring healthcare harms for racialised groups with SMIs that need to be addressed. Our findings suggest a need to address these, not only in mental health providers, but across the whole health and care system and a need to ensure more equitable healthcare partnerships with service users, carers, and communities from racialised backgrounds who are often excluded.

Efficacy of the Nutrition Education and Screening Tool as a Foundation for Exploring Perinatal Diet and Determinants in Aboriginal and Torres Strait Islander Women of Far North Queensland.

Assessing perinatal diet and its determinants in Australia's Aboriginal and Torres Strait Islander women remains challenging, given the paucity of tools that incorporate Aboriginal ways of knowing, being, and remembering within a quantitative framework. This study aimed to explore the determinants of perinatal nutrition in this population and to evaluate the efficacy of the Nutrition Education and Screening Tool (NEST) in collecting diet-related data in this population. This study employed a Participatory Action Research approach using the NEST as a foundation for structured research inquiry. Self-reported diet and determinants were collected from a cross-sectional cohort of Aboriginal and Torres Strait Islander women from Far North Queensland. Participants (n = 30) declared excess consumption of meat and alternatives, fruit, vegetables and legumes, and dairy and alternatives. Grain and cereal consumption aligned with recommendations; wild-harvested foods comprised a mean 19.75% of their protein intake. Food frequency data were supported by participants' descriptions of how they eat, combine, rotate, and cook these foods. Standard food frequency questionnaires are challenging for Aboriginal and Torres Strait Islanders as their concepts of time and ways of remembering are different from Western understanding. Use of the NEST allowed food frequency items to be explored, clarified, and cross-referenced; yarning provided a degree of support for quantitative data. The results of this study translate to future public health research, practice, and policy. Alternative quantitative measures to determine food frequency should be considered in future studies. These may include the cyclical approach to time that is well understood and integrated by Indigenous cultures.

Peningkatan Pola Asuh Melalui Penyuluhan Gizi dan Kesehatan di Kelurahan Samaan, Kota Malang

Nutrition and health counseling in Samaan Village, Malang City, aims to increase parents' understanding of the importance of proper parenting in supporting child development, especially in the context of stunting prevention. Through a Participatory Action Research (PAR) approach, this activity involved posyandu cadres and the PKK mobilizing team in designing and implementing counseling. The materials presented focused on balanced nutrition, psychological stimulation, and the importance of routine health checks for toddlers. The results of the counseling showed an increase in parents' understanding of the importance of nutrition in supporting children's physical and cognitive development, as well as the application of better parenting.