Peer Education Research Articles

ESPRIT study, analysis of the results of the pre-intervention survey in upper secondary schools

Abstract Background Sexually transmitted infections are a major public health problem, and their number is increasing in Italy. However, affective sexuality education is not yet part of the curricula. Therefore, a project entitled ESPRIT was launched, involving 3 regions (Friuli-Venezia Giulia, Lazio and Sicily), the IRCSS ‘Burlo Garofolo’ and the Istituto Superiore di Sanità, and implemented with the technical and financial support of the Ministry of Health - CCM. Methods A multicenter prospective intervention study was designed involving public upper secondary school students (grade 10-11). All target groups completed a KAP (knowledge, attitude, practice) questionnaire before and after participation in the educational intervention to measure its effectiveness. The questionnaires from the first phase were collected between January and April 2024, and the results were analyzed using R statistical software. Results The analysis of the overall results (463 students in total; female 58%, male 39%, other 2%; FVG 49%, Lazio 25%, Sicily 26%) showed that the group of upper secondary school students, targeted by peer education answered the knowledge part correctly by 56.6±13.8% on average. Applying the Kruskal-Wallis test showed that the percentage was significantly higher for females than males (p-value=0.005) and for licei students compared to technical and vocational schools (p-value=0.000). In terms of to attitudes, only 17% of students talked at length about sexually transmitted infections, and in 86.6% of cases, the interlocutors were friends or peers. Conclusions The results of the first phase show differences between the sexes and between the different types of educational institutions. The current level of knowledge still leaves much room for intervention and improvement. Analyzing the results of the follow-up phase will allow us to understand the effectiveness of the peer education intervention. Key messages • Adolescents’ knowledge of sexually transmitted infections needs to be improved. • Gender and the type of school attended affect the level of knowledge.

Preparing for the Implementation of Long-Acting Injectable Cabotegravir for HIV Pre-Exposure Prophylaxis Within the Brazilian Public Health System (ImPrEP CAB Brasil): Qualitative Study.

Although long-acting, injectable cabotegravir (CAB-LA) pre-exposure prophylaxis (PrEP) has proven efficacious for HIV prevention in clinical trials, research is needed to guide effective implementation in real-world settings. Formative work with community members and health care providers (HCPs) is important to provide insight into the needs and contexts of specific populations and reveal potential barriers and facilitators for implementation projects. We aimed to describe the results from formative work to develop an implementation package for CAB-LA PrEP within the ImPrEP CAB Brasil study. ImPrEP CAB Brasil is an implementation study of same-day delivery of CAB-LA PrEP for young sexual and gender minority (SGM) groups (aged 18-30 years) in 6 existing oral PrEP public health clinics. We conducted formative research to prepare for the implementation of ImPrEP CAB Brasil through community mobilization, process mapping with HCPs with experience in CAB-LA, and focus group discussions (FGDs) with young SGM groups (n=92) and HCPs (n=20) to identify initial perceptions of facilitators and barriers for CAB-LA PrEP implementation, refine the mobile health (mHealth) educational tool, and evaluate the acceptability of using a text message appointment reminder intervention through WhatsApp. FGDs were recorded, transcribed, systematically coded, and analyzed with thematic categorization by trained researchers using a qualitative data analysis program ATLAS.ti (version 7). A community mobilization team comprising 34 SGM community leaders collaborated in creating a prototype for an mHealth educational tool and contributed to the planning of peer education activities. We created 3 process maps for each site to describe the initial visit, follow-up visits, and laboratory flow. The main challenge identified for same-day CAB-LA PrEP delivery was the extended duration of clinic visits due to the numerous laboratory tests and HIV counseling steps required. Proposed solutions included having point-of-care HIV rapid tests instead of laboratory tests and additional counseling staff. Barriers for CAB-LA PrEP implementation identified through FGDs were the training of HCPs, support for adherence to injection appointments, and stigma or discrimination against SGM groups and persons using PrEP. The mHealth educational tool and WhatsApp reminders were highly acceptable by SGM groups and HCPs, indicating their potential to support PrEP choice and adherence. Content analysis on the cultural appropriateness of the language and overall clarity of the material contributed to the refinement of the mHealth tool. Structured formative work with SGM persons and HCPs generated important refinements to context-specific materials and plans to launch ImPrEP CAB Brasil in public health clinics. Ongoing implementation monitoring will use the process maps to identify additional barriers and potential solutions to same-day delivery of CAB-LA PrEP. Summative evaluations are needed to measure the effectiveness of the mHealth educational tool to support PrEP choice and the use of WhatsApp appointment reminders.

Implementation of an HIV Prevention Intervention at Historically Black Colleges and Universities and Predominantly Black Institutions

Black Americans and the Southern United States are disproportionately represented in the HIV epidemic. Historically Black Colleges and Universities (HBCUs) and Predominantly Black Institutions (PBIs), often located in communities that have been historically underserved, are uniquely positioned to implement HIV prevention interventions focused on Black young adults. The purpose of the current study was to conduct a qualitative study, using the Consolidated Framework for Implementation Research (CFIR) model as a guide, to identify the barriers and facilitators to implementing an HIV intervention pre- and post-implementation. Pre-implementation key informant interviews with administrators, faculty, and staff, alongside focus groups with students, highlighted several themes as potential influencers on intervention rollout. These included perceived need, campus health resources, cost, personnel availability, student priorities, HIV-related stigma, and institutional culture. Post-implementation interviews with campus liaisons further revealed themes including institutional culture, external partnerships, internal communication, student health resource accessibility, and peer educator recruitment and retention. These findings underscore the complexities of implementing public health interventions in academic settings and may guide future efforts at HBCUs and PBIs to effectively address HIV prevention.

Youth-led Mental Health Promotion in South Africa

Globally, youth have high rates of unmet mental health needs, especially in Majority World contexts. Youth themselves are well positioned to engage their peer group in mental health provision. The aim of this study was to explore how peer educators could co-produce and deliver mental health promotion in resource-constrained South Africa communities. Six peer educators aged 18 to 24 initially co-facilitated consultation with 209 youth, before designing and delivering three mental health promotion workshops to 179 youth. Peer educators and 21 workshop beneficiaries participated in focus groups on their experiences. Key findings related to involving youth by integrating mental health to community activities, using participatory approaches, applying and transferring knowledge, signposting for further help, and putting support mechanisms in place. In conclusion, youth hold unique expertise in mobilizing their peer group and promoting mental health. Peer educators should be incorporated in service systems, with allocated budgets, training, supervision.

Return-on-Investment Analysis of an Enhanced Community Doula Program: Pre- and Post-COVID-19 Considerations.

Community doulas are perinatal health workers who provide peer education, resource navigation, and support during pregnancy, childbirth, and the postpartum period. Evidence suggests that doulas improve the experience of care, reduce cesarean birth, and improve breastfeeding outcomes. However, people with low incomes cannot access affordable community doula support in most states due to lack of insurance reimbursement. To determine the affordability of Medicaid reimbursement for doula services, there is a need to fill a gap in research that employs real-world data and a return-on-investment (ROI) analysis approach. We conducted a ROI analysis from the healthcare perspective of an enhanced community doula intervention, Best Beginnings for Babies (BBB). Healthcare and program cost data were collected alongside clinical outcomes from a randomized controlled trial of routine maternity care at Boston Medical Center with and without BBB. ROI was calculated as the net healthcare savings divided by the investment costs. Post-COVID-19 program costing estimates were also performed. Average healthcare costs per patient were $18,969 for the BBB group compared with $20,121 for routine care, a savings of $1,152. BBB program costs were an average of $971 per person. There was an 18% ROI. Lower costs for the birth hospitalization and NICU stays accounted for the largest areas of savings. Per-person program costs using proposed MassHealth fees produced a positive return on investment, although 2023 hospital doula program wages and salaries did not. The BBB-enhanced community doula program was cost-saving to payers and increased access to doula support for low-income people. Even with post-COVID-19 increases in program costs, analysis demonstrated doula support was still financially feasible. This study should reassure budget-conscious Medicaid payers that doula services are affordable.

Evaluation of the Sources of Sexual Knowledge and Information among Men in Kenya

AbstractSources of sexual knowledge and information among men have impact on quality of their sexual literacy and decision making. Sexual knowledge impacts on sexual attitudes, which underpin sexual behaviours and in turn impacts the sexual health outcomes of men. A cross-sectional quantitative survey was used to assess the sources of sexual knowledge and information among 484 Kenyan adult men aged 18–54. Data analysis was performed with STATA-16. Results showed that 79% of men learned about sex from school-based sex education, 75% and 72% from peers and mass media respectively while healthcare professionals (35%) and parents (28%) had the lowest influence on sexual knowledge and information. Understanding men’s sources of sexual knowledge and information that informs their sexual decision making can influence sexuality education planning and sexological practice policies targeted to out of school youths and older men. Hence, appraising formal peer educator’s knowledge could provide transformative sexual and reproductive health support services to men.

Integrating digital and interactive approaches in adolescent health literacy: a comprehensive review.

Adolescent health literacy is critical for navigating the complex landscape of modern healthcare and making informed decisions that influence long-term health outcomes. This comprehensive review synthesizes current research on integrating digital tools and interactive learning approaches to enhance health literacy among adolescents. We explore the use of digital technologies, such as mobile apps and virtual reality, which cater to the preferences of this tech-savvy generation, offering personalized and accessible health information. The effectiveness of interactive learning methodologies, including simulations and role-playing, is also examined, highlighting their potential to increase engagement and retention of health-related knowledge. We address the importance of mental health literacy and the role of social media and peer education in disseminating health information effectively. Our review identifies gaps in the current literature, particularly the need for studies that consider long-term outcomes and the impact of socioeconomic and cultural factors on health literacy initiatives. We propose a multidimensional approach to health literacy education that incorporates innovative technologies and interactive methods to meet the diverse needs of adolescents in various contexts. The findings suggest that an integrated approach, including digital and critical health literacy, is essential for developing comprehensive health education programs that are both informative and engaging for adolescents.

THE EFFECT OF PEER EDUCATION ON SLEEP HYGIENE ON SLEEP QUALITY AND PSYCHOLOGICAL RESILIENCE IN UNIVERSITY STUDENTS LIVING IN DORMITORIES

This study was conducted to examine the effect of peer education on sleep hygiene sleep quality and psychological resilience in university students living in dormitories. In the study, a quasi-experimental method with a pretest-posttest control group was used. 240 university students staying at Akyazı Credit and Dormitories Institution in Akyazı district of Sakarya province participated in the study. Half of the students (n=120) formed the intervention group and the other half (n=120) formed the control group. Before the study, 20 students were given sleep hygiene training by the research team. The training group provided peer education to the intervention group on sleep hygiene. No intervention was made in the control group. Student diagnostic form, Sleep Hygiene Index, Pittsburgh Sleep Quality Index, and Brief Psychological Resilience Scale were used as data collection tools. There was no statistically significant difference between the Sleep Hygiene Index and Brief Psychological Resilience Scale score averages of the intervention and control group students included in the study at the beginning and the last interview (p>0.05). However, it was determined that there was an improvement in the sleep hygiene and psychological resilience levels of the students in the intervention group (p0.05). In addition, it was determined that the intervention group had a significant improvement in subjective sleep quality and sleep latency, which are sub-dimensions of the Pittsburgh Sleep Quality Index (p

Comparing the Effects of Healthy Lifestyle Education Through Peer Group and mHealth App on Self-esteem in Patients with Diabetes Mellitus: A Randomized Controlled Trial

Background: The increasing prevalence of diabetes mellitus has become a global public health challenge in recent decades. However, disease-related complications can be minimized through innovative educational programs. Objectives: This study aimed to compare the effects of healthy lifestyle education delivered via peer group and the mHealth app on self-esteem in patients with type 2 diabetes mellitus (T2DM). Methods: This three-group randomized controlled trial was conducted in 2022. A total of 135 patients living with T2DM were recruited using purposive sampling from two hospitals in Kermanshah Province, Iran, and then divided into three groups: Peer education, virtual education, and control groups, via replacement randomization. Peer patients with T2DM, previously trained by the researchers, provided education to those in the peer education group in four 35-minute sessions over two days. Simultaneously, patients in the virtual education group were trained by the researchers using the mHealth app, specifically designed for this purpose, in three 1-hour sessions over three days. Data were collected using the Patient Profile Form and the self-reported Rosenberg’s Self-Esteem Scale. The data were analyzed using IBM SPSS Statistics software, employing paired-sample t-tests, chi-square tests, Fisher’s exact tests, and one-way analysis of variance (ANOVA) for comparisons. Results: Before the intervention, there were no significant differences in the self-esteem mean scores between the study groups (P = 0.665). However, post-intervention, the self-esteem scores differed significantly between all groups (P = 0.002). The self-esteem mean scores of patients in the peer education group (100.36 ± 15.9 vs. 106.87 ± 9.08, P = 0.011) and the virtual education group (100.80 ± 24.72 vs. 116.91 ± 10.67, P = 0.018) significantly increased after the intervention, while no significant difference was observed in the control group (106.87 ± 9.08 vs. 105.60 ± 10.84, P = 0.134). Virtual education via the mHealth app was more effective than peer education in improving self-esteem in patients with T2DM. Conclusions: The healthy lifestyle education program delivered through virtual education via the mHealth mobile app led to higher self-esteem among patients with T2DM compared to peer education. It is suggested that future studies investigate the impact of virtual education using mobile-based apps and artificial intelligence capabilities on self-esteem in other patient populations. These results can serve as guidelines for the optimal use of distance education and educational apps for patients with chronic diseases.

Development and feasibility of the peer and nurse-led HIV Self-Testing Education and Promotion (STEP) intervention among social networks of men in Dar es Salaam, Tanzania: application of the ADAPT-ITT model

BackgroundAccording to the 2016–2017 Tanzania HIV Impact Survey, only 45% of men living with HIV (MLWH) were aware of their HIV status. In an effort to increase HIV testing in Tanzania, including among men, the Government of Tanzania passed a law in December 2019 allowing HIV self-testing (HIVST) to be included in the national testing strategies. The objective of this paper is to describe the development and pilot feasibility assessment of the Self-Testing Education and Promotion (STEP) intervention, which includes male peer education and demand creation for HIVST, and nurse-led distribution of HIVST kits in a community setting.MethodsThe development and piloting processes were guided by the ADAPT-ITT model and informed by a national PEPFAR/USAID-funded HIV implementation science project called Sauti.The adapted STEP intervention included the following two components: 1) peer-based HIVST promotion; and 2) nurse-led HIVST distribution. For the feasibility assessment, 25 men were selected and trained as peer educators in 2019 to promote HIVST among their peers before recruiting 253 men who received instructions and an HIVST kit from a nurse at a community-based study tent site.ResultsOf the 236 participants who completed the 1-month follow-up survey, 98.3% reported using the kit. The majority (92.4%) of participants reported a negative HIVST result while 4.2% (n = 10) received a positive result. Most (70%, n = 7) of the participants with a positive result sought follow-up services at a healthcare facility while 40.3% (n = 95) of the participants with a negative self-test result visited the community-based project site. Most of the men (53%, n = 129) did not visit a healthcare facility or the study site.ConclusionThe findings demonstrate that the combined peer-based promotion and nurse-led distribution of HIVST intervention was acceptable and feasible, though seeking follow-up services at healthcare facilities remained low. Future research should evaluate the effectiveness of offering nurse-led community-based clinical follow-up services in addition to HIVST rather than referral to facilities.

Comparison of the effects of nursing and peer education on quality of life and resilience in patients with multiple sclerosis: A randomized clinical trial

BackgroundMultiple sclerosis (MS) is a prevalent disease of the central nervous system that often leads to diminished resilience and quality of life in affected individuals. This study aims to compare the effects of nursing and peer education on improving the quality of life and resilience in patients with multiple sclerosis. Materials and methodsThis three-group clinical trial study was conducted before and after interventions at the MS Society in Hamedan, Iran. In this study, 120 patients with MS were randomly selected and assigned to three groups: nurse education, peer education, and control. Quality of life and resilience questionnaires were self-reported before and two months after the completion of the intervention. The educational sessions were conducted over five meetings, each lasting between 45 and 60 min, held every two days. Group one received education led by nurses, while group two participated in peer-led education sessions. ResultsThe results indicated that before the intervention, there were no significant statistical differences in demographic variables, resilience, and quality of life among the three groups (p > 0.05). However, after the intervention, both the peer and nurse groups showed a significant increase in quality of life and resilience compared to the control group (p < 0.05). Nevertheless, no differences were observed between the nurse and peer groups regarding these variables (p > 0.05). ConclusionsBoth nursing and peer education methods had an equal impact on enhancing the resilience and quality of life of patients with MS. It is recommended that peer support be utilized to empower MS patients, especially in contexts where there is a shortage of nurses.

Combined interventions for the testing and treatment of HIV and schistosomiasis among fishermen in Malawi: a three-arm, cluster-randomised trial

Undiagnosed HIV and schistosomiasis are highly prevalent among fishermen in the African Great Lakes region. We aimed to evaluate the efficacy of lakeside interventions integrating services for HIV and male genital schistosomiasis on the prevalence of schistosomiasis, uptake of antiretroviral therapy (ART) for HIV, and voluntary male medical circumcision (VMMC) among fishermen in Malawi. We conducted a three-arm, cluster-randomised trial in 45 lakeshore fishing communities (clusters) in Mangochi, Malawi. Clusters were defined geographically by their home community as the place where fishermen leave their boats (ie, a landing site). Eligible participants were male fishermen (aged ≥18 years) who resided in a cluster. Clusters were randomly allocated (1:1:1) through computer-generated random numbers to either enhanced standard of care (SOC), which offered invitation with information leaflets to a beach clinic offering HIV testing and referral, and presumptive treatment for schistosomiasis with praziquantel; peer education (PE), in which a nominated fisherman was responsible for explaining the study leaflet to promote services to his boat crew; or peer distribution education (PDE), in which the peer educator explained the leaflet and distributed HIV self-test kits to his boat crew. The beach clinic team and fishermen were not masked to intervention allocation; however, investigators were masked until the final analysis. Coprimary composite outcomes were the proportion of participants who had at least one Schistosoma haematobium egg observed on light microscopy from 10 mL of urine filtrate and the proportion who had self-reported initiating ART or scheduling VMMC by day 28. Outcomes were analysed by intention to treat; multiple imputation for missing outcomes was done; random-effect binomial models adjusting for baseline imbalance and clustering were used to compute unadjusted and adjusted risk differences, risk ratios (RRs) and 95% CIs, and intracluster correlation coefficients for each outcome. This trial is registered with ISRCTN, ISRCTN14354324. Between March 1, 2022, and Jan 29, 2023, 45 (65·2%) of 69 clusters assessed for eligibility were enrolled in the trial, with 15 clusters per arm. Of the 6036 fishermen screened at baseline, 5207 (86·3%) were eligible for participation: 1745 (87·6%) of 1991 in the enhanced SOC group, 1687 (81·9%) of 2061 in the PE group, and 1775 (89·5%) of 1984 in the PDE group. Compared with the prevalence of active schistosomiasis in the enhanced SOC group (292 [16·7%] of 1745), 241 (13·6%) of 1775 fishermen in the PDE group (adjusted RR 0·80 [95% CI 0·69-0·94]; p=0·0054) and 263 (15·6%) of 1687 fishermen in the PE group (0·92 [0·79-1·07]; p=0·28) had schistosomiasis at day 28. 230 (13·2%) in the enhanced SOC group, 281 (16·7%) in the PE group, and 215 (12·1%) in the PDE group initiated ART or were scheduled for VMMC. ART initiation or VMMC scheduling was not significantly increased with the PDE intervention (0·88 [0·74-1·05); p=0·15) and was marginally increased with the PE intervention (1·16 [0·99-1·37]; p=0·069) when compared with the enhanced SOC group. No serious adverse events were reported in this trial. We found weak evidence for the use of peer education to increase uptake of ART and VMMC, but strong evidence for the added distribution of HIV self-test kits to promote high engagement with services and reduce the prevalence of active schistosomiasis, suggesting a high potential for scale-up in hard-to-reach communities across Malawi. Wellcome Trust and the UK National Institute for Health Research.

Investigating the effect of peer-led educational intervention on behaviors related to pubertal health and its determinants in high school girls of Genaveh, Iran: Application of social cognitive theory

Background Empowering adolescents in the field of puberty health is one of the important goals of public health programs. The present study was carried out with the aim of determining the effect of peer-led training on puberty-related behavior and its determinants using social cognitive theory. Methods: A total of 245 teenage girls were randomly divided into two groups: the intervention group and the comparison group. The questionnaire measuring puberty-related behavior and its determinants was self-administered and completed before and 2 months after training in the two groups. One session for parents, four sessions for peer educators, and four sessions for participants were conducted for 1 month. Results: In the intervention group, unlike the comparison group, the mean scores of knowledge, outcome expectations, self-efficacy, self-control, social support, and behavior increased significantly after training (p <0.05). Based on regression analysis, outcome expectations and social support were the main determinants of puberty-related behavior (adjusted R2 = 0.464). Conclusion: The findings of this study support the effectiveness of the peer-led educational intervention based on social cognitive theory in the improvement of puberty-related behavior and its determinants, which can be used in the design of puberty-related health promotion programs. Further research to assess the longer-term outcomes and to examine other theories of behavior change are suggested.

The Impact of Peer-Led Learning Groups on First-Year Medical Students.

Active learning and peer instruction contribute to positive learning outcomes. We developed a 25-week, question-based program for first-year medical students (MS1). Senior students developed weekly question and answer sets. Second-year peer educators helped MS1s learn to collaboratively problem solve by working through the questions and answer explanations. Controlling for average MCAT 2015 score, attendance significantly correlated with improved academic performance in basic science coursework (beta = 0.196, p < .001) and one organ systems module (beta = 0.104, p = .033). Academic outcomes and an 83% sustained participation rate point to the benefits of peer-led, positive learning environments.

Experiences of peer educators in a high school sexual and reproductive health peer education programme in Rwanda

Background: To contribute to a reduction in teenage pregnancy among in-school adolescents in Rwanda, a sexual and reproductive health peer education programme (SRHPEP) was developed and implemented. Reflecting on the unique characteristics of this newly implemented programme, and understanding peer educators’ (PEs) and facilitators’ perspectives, can provide insights into the programme’s effectiveness and feedback to improve the programme in the future. This study explored the experiences of being a PE in the SRHPEP from the perspectives of PEs and facilitators. Design: Qualitative exploratory design. Setting: Data collection took placed in three public high schools in Rwanda. Method: Three focus group discussions (FGDs) with 22 PEs and 5 in-depth interviews with facilitators were conducted. Results: Thematic analysis identified the benefits of being a PE, including increased competence, enhanced relationships and an improved society’s understanding of sexual and reproductive health (SRH). PEs faced challenges, however, including bullying, limited resources and time constraints. A support system (comprising PEs themselves, facilitators and school leadership) and refresher training made being a PE easier. Study participants suggested allocating enough time, training larger numbers of PEs and the provision of contextually relevant educational materials to improve the programme. Conclusion: Findings from this study can be used to guide the development of future ways of strengthening the SRHPEP in schools. They can also help to ensure that PEs are adequately supported in their roles and the needs of the students are met.

Religious-Based Peer Education in Preeclampsia Prevention: Social Cognitive Theory and Information, Motivation, Behavioral Skill Model Approach to Improve Preeclampsia Preventive Behavior in Indonesia

Background:Preeclampsia is the second leading cause of maternal death, largely due to the failure to identify the condition early. Prevention behaviors for preeclampsia in pregnant women can be developed through the Social Cognitive Theory (SCT) and the Information-Motivation-Behavioral Skills (IMB) Model. Utilizing religious organizations with unique values and cultures to foster high levels of compliance, a Religious-Based Peer Education approach can optimize these preventive efforts. Objective:This research aims to analyze the influence of knowledge, skills, motivation, observational learning, husband's support, and self-efficacy on the formation of preeclampsia prevention behaviors. Methods:A non-equivalent pre- and post-test design was conducted in Bojonegoro district from August 2022 to February 2023. The sample consisted of 179 pregnant women in the intervention group and 168 in the control group. The intervention involved Religious-Based Peer Education, with peers being members of the Muslimat NU religious organization, while the control group received routine assistance from existing health cadres. Data were analyzed using path analysis. Results:The mean scores for knowledge, skills, and behavior in the intervention group were significantly higher than those in the control group (13.81 vs. 12.34; 2.37 vs. 1.95; 30.33 vs. 28.19; p &lt; 0.001). The strongest factors influencing the formation of preeclampsia prevention behavior were screening skills (b = 0.74, p = 0.010; 95% CI: 0.03–0.23) and self-efficacy (b = 0.36, p = 0.010; 95% CI: 0.23–0.48). Conclusion:The SCT and IMB models, when applied through Religious-Based Peer Education, have proven effective in improving preeclampsia prevention behaviors. Ongoing training for peers and consistent support for pregnant women are essential to identify high-risk pregnancies and prevent maternal complications. Keywords: social cognitive theory; information-motivation-behavioral skills model; preeclampsia; religious-based peer education; behavior

Diabetic Patients’ Perception of Diabetic Foot Ulcers: A Qualitative Study

Background: Diabetic foot ulcer (DFU) is one of the serious and debilitating challenges faced by patients with diabetes, which imposes a financial burden on both patients and healthcare systems. Although this problem can be prevented and treated by proper foot care techniques, many patients do not follow the recommendations. Accordingly, this study aimed to rely on deep insight and knowledge to explain diabetic patients’ perception of DFU and identify appropriate care and support practices to prevent and manage it. Methods: This descriptive study was conducted using qualitative content analysis. The participants were 15 patients with diabetes, who visited the healthcare centers in Shahrekord, Iran selected using purposive sampling. Data were collected through face-to-face and semi-structured interviews with the participants until data saturation. Data were analyzed simultaneously with data collection using the method proposed by Graneheim and Lundman. Results: Data analysis led to the identification of four main categories including being destined to a doomed fate, self-treatment, indifference to obsessive care, and care-inhibiting beliefs. Conclusion: To gain a deeper understanding of standard foot care, the causes of foot ulcers, preventive care services, and existing treatments, different strategies can be adopted such as peer education or using the experiences of other patients with ulcers.

The Effectiveness of Interventions Targeting Adolescents in HPV Vaccination-A Scoping Review.

Adolescents are the target group for HPV vaccination. Studies that examine factors influencing acceptability among adolescents and interventions aimed at improving knowledge, attitudes, perceptions, intentions, and, most importantly, vaccination rates are less common than those addressing parents or healthcare professionals. The specialized literature was searched for studies evaluating the impact of various interventions on adolescents. In the final analysis, 41 studies were included (35 original studies and 6 reviews). Educational interventions increased adolescents' knowledge scores in the selected studies. Peer education proved highly effective in rapidly and significantly improving knowledge about HPV. Additionally, multicomponent interventions generated awareness and knowledge that persisted for months after the interventions. HPV vaccine uptake increased following educational interventions in 11 out of the 14 studies that evaluated this outcome; studies presenting multicomponent interventions also proved effective in improving vaccination rates. Higher HPV vaccine series completion was reported following a reminder system strategy. Interventions directed at adolescents, combined with strategies involving parents and healthcare professionals, can play an important role in improving HPV vaccination rates. Educated adolescents must be involved in decisions about their own health and can be a valuable source of information for their peers and parents.

Abstract B071: Mothers Informed Lactation Knowledge and Support (MILKS): Addressing Cancer Disparities through Community Action

Abstract Purpose: The Mothers Informed Lactation Knowledge and Support (MILKS) project aims to increase breastfeeding initiation and duration in Aiken County, South Carolina, specifically among Black/African American (B/AA) and Hispanic women. Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death from 2012-2016 in this county. Methods: In collaboration with the Aiken Maternal Health Workgroup, a community health needs assessment was conducted. Listening sessions, health data review, and an environmental scan were conducted. A community report card was developed to disseminate and identify intervention needs. Areas assessed include: knowledge of cancer prevention, breastfeeding resources, lactation consultant/peer educators, breastfeeding friendly employers, and community support. Results: Aiken Co. has a total population of 174,150, 37% of the population lives in rural areas, 24.7% are non-Hispanic B/AA, 6.3% are Hispanic, and 12% of the population is uninsured. The breastfeeding initiation rate is 77.2 % (64.3%, B/AA and 86.7% Hispanic), compared to 78.5 percent for South Carolina and 83.2 percent for the United States. Breast cancer 5-year incidence rate all women is similar between Aiken (124) and South Carolina (129) /100,000, and breast cancer mortality rate is higher in Aiken (25) vs. SC (22) / 100,000 age-adjusted population. B/AA women have a significantly higher rate of breast cancer incidence (98.0) and mortality (37.8)/100,000 than state and national averages. There is an inappropriate number of lactation consultants and peer educators – only 1 is available to a limited population in-person, 2 are available to WIC recipients virtually. The WIC office also has two peer counselor positions, both of which were vacant at the time of research. Community listening sessions (n=4) provided insight into language and cultural barriers in accessing breastfeeding resources. Specifically, Hispanic women expressed difficulties in finding culturally relevant information and assistance. Participants highlighted the importance of education, advocating for improved workplace accommodations, such as designated lactation spaces and flexible scheduling, to enable breastfeeding mothers to manage the challenges of returning to work while continuing to breastfeed. No one reported previous knowledge of cancer prevention through breastfeeding. A lack of social norms for breastfeeding was also identified. Conclusions: Recommendations based on the report card include expanding peer education programs, enhancing workplace support, and ensuring cultural and linguistic inclusivity in breastfeeding education and support, and cancer prevention resources. The next steps include implementing additional peer education programs in the community, with a focus on cancer prevention through education, screening, and community support. This project provides a replicable blueprint for addressing cancer disparity through community engagement and collaboration. Citation Format: Marlo Vernon, Brianna McIndoe, Ananya Chakraborty, Elinita Pollard. Mothers Informed Lactation Knowledge and Support (MILKS): Addressing Cancer Disparities through Community Action [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B071.

Abstract B070: Addressing health disparities around breastfeeding: Development of a braided curriculum

Abstract Purpose: Breastfeeding initiation and longer duration are known to reduce risk of breast and ovarian cancer. While racial disparities in breast cancer diagnosis and mortality rates exist in the United States, disparate rates of breastfeeding initiation and duration continue to widen. The positive effects of these community lactation support through peer education programs among Black mothers have been demonstrated, but these programs are limited by the lack of reach to vulnerable families. Integration of lactation education and support within parenting programs targeting complementary maternal behaviors, such as psychosocial stress does not exist. This proof-of-concept study uses novel Systematic Braiding methodology to develop an integrated maternal behavior parenting curriculum. Methods: In line with the systematic braiding technique, key stakeholders of two evidence based programs, Intergen (a culturally competent breastfeeding peer-educator program) and SafeCare® (a widely disseminated evidence-based parenting program), were consulted to identify core program components, shared and unique theoretical constructs, and programmatic targets including: population of interest, behaviors, delivery mode, program content, dose and length, assessment, fidelity monitoring. Results: 10 program developers and content experts identified shared and unique theoretical constructs and programmatic targets including: population of interest – at-risk minority parents, behaviors (parenting, breastfeeding, and cancer prevention), delivery mode (in person and self-guided), program content, dose and length, assessment, and fidelity monitoring. Areas of integration were captured to inform the braiding of the new curriculum based in social cognitive theory and the theory of planned behavior including modules on cancer education, prevention through breastfeeding, and screening were captured to inform the braiding of the new curriculum. Future directions will assess the acceptability and feasibility of the braided curriculum via user-centered feedback across informants from each of four key informant groups: 1) target recipients of the curriculum including Black women, &amp;lt;36 weeks gestation; 2) potential program providers; 3) community health care professionals; and 4) state-level legislative representatives. Interim findings will be presented. Discussion: There is limited exploration on using widely disseminated parenting programs to increase breastfeeding uptake among African American mothers. This study takes first steps towards developing a robust intervention to increase the reach of breastfeeding education to expecting African American mothers through a widely disseminated parenting model. Improving knowledge of cancer prevention through breastfeeding along with behavior (initiation and duration) among this at-risk population may positively impact breast and ovarian cancer risk. Citation Format: Marlo Vernon, Ashwini Tiwari, Elinita Pollard, Biplab Datta, Zach Hoffman, Kate Guastaferro, Shannon Self-Brown. Addressing health disparities around breastfeeding: Development of a braided curriculum [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B070.