Community Prevention Programs Research Articles

Risk and Protective Factors in Children Bullying Perpetration: Application of the Multiple Disadvantage Model.

This secondary study examined bullying perpetration's relationships with social disorganization, social structural factors, social relationships, mental health, and access to health insurance and care. A sample of 30,173 children age 6 to 17 years was extracted from the 2021 National Survey of Children's Health for secondary data analysis. Logistic regression results demonstrated that these children's likelihood of bullying perpetration was positively associated with racial discrimination, child age 6 to 10 years, child age 11 to 13 years, parent education level, employed parent, neighbor support, family violence, difficulty parenting the child, child difficulty with peers, child behavioral/conduct problems, family substance use problem, and child receipt of mental health services; such likelihood also had negative associations with safe neighborhood, Black, Asian, other non-Hispanic ethnic minority, parent age, and family cohesiveness. Implications included interventions to promote awareness of racial discrimination for families as well as bully prevention programs in schools and communities.

Development of a Community-Driven Waste Reduction Education and Action Program

Mismanaged and excessive waste has adverse effects on natural environments, economies, and human health. To address these waste issues, the Sustainability with Awareness and Prevention Solutions Program was developed and implemented in communities along the Mississippi Gulf Coast (USA) with the aim to provide the knowledge and actions needed to reduce or eliminate mismanaged and excessive waste. The program uses four educational modules focused on (1) microplastics in the watershed, (2) food waste, (3) single-use plastics, and (4) involvement in community prevention and removal programs. The program curriculum was written to meet education standards in Mississippi for 5th grade gifted, 6–8th grades, and 9–12th grades, and can be easily adapted to other states’ curriculums. The program provides material incentives to participants so knowledge learned can immediately be translated to behavior change. The program is continually being developed to find the best methods to implement behavior change at multiple scales.

Healthier Together: Implementation and evaluation of a co-designed, culturally tailored childhood obesity community prevention program for Māori and Pacific Islander children and families.

Co-designed and culturally tailored preventive initiatives delivered in childhood have high potential to close the cross-cultural gap in health outcomes of priority populations. Māori and Pacific Islander people living in Australia exhibit a higher prevalence of overweight and obesity and higher rates of multimorbidity, including heart disease, cancer and diabetes. This mixed-methods, pilot implementation and evaluation study, aimed to evaluate the implementation of a community-based, co-designed and culturally tailored childhood obesity prevention program, using quantitative (pre-post anthropometric measurement, pre-post health behaviour questionnaire) and qualitative (semi-structured interview) methods. Sessions relating to healthy eating, physical activity and positive parenting practices were delivered to families residing in Brisbane (Australia) over 8-weeks. Data were collected from a total of 66 children (mean age 11, SD 4) and 38 parents (mean age 40, SD 8) of Māori and Pacific Islander background, from July 2018 to November 2019. Anthropometric changes included a reduction in Body Mass Index (BMI) z-score among 59% of children (median change -0.02, n = 38, p = 0.17) and BMI among 47% of adults (median change +0.06 kg/m2, n = 18, p = 0.64). Significant improvements (p < 0.05) in self-reported health behaviours from pre- to post-program included increased vegetable consumption among children, decreased discretionary food intake of children, decreased discretionary drink consumption among both children and adults, increased minutes of daily physical activity among adults and increased parental confidence in the healthy diets of their children. Qualitative data revealed participants valued the inclusion of all family members, learning of practical skills and cultural tailoring delivered by the Multicultural Health Coaches. This study provides preliminary evidence that the Healthier Together program improved self-reported health behaviours and physical activity levels among Māori and Pacific Islander children and their families in the short-term; however, due to the small sample size, these results must be interpreted carefully. The program empowered change via cultural tailoring and accessibility; however, long-term implementation and evaluation with a larger cohort is needed to validate the observed health behaviour improvements and their sustainability. SO WHAT?: The co-design framework that informed program development and key learnings of implementation will provide guidance to health practitioners, health workers, public health professionals and policy makers to develop inclusive and pragmatic co-design solutions for priority cultural populations in Australia. Health outcomes will improve as a result, promoting health equity for future generations.

Perceived barriers to healthy eating among overweight and obese women: a qualitative study

Introduction: Being overweight/obese is a global epidemic and one of the leading causes of cardiovascular diseases (CVD). Knowing the barriers to a healthy lifestyle in target populations is necessary to further reduce the burden of overweight/obesity, which can ultimately reduce the mortality and morbidity following non-communicable diseases (NCDs). Objectives: To describe the perceived barriers to healthy eating among 35-44 aged overweight/obese women. Methods: A qualitative study was conducted in Panadura Medical Officer of Health (MOH) Area in the district of Kalutara, Sri Lanka. The data were collected using semi-structured in-depth interviews conducted among 18 overweight/obese women. Content analysis of the qualitative data was conducted manually. Coding was decided following a discussion with two independent experts in the field of public health. Using the inductive approach to data analysis ensured that the interpretations and codes of the study were generated from the actual data. Results: The study identified three main themes which included personal, social, cultural, and environmental barriers as key factors for perceived healthy eating. Under the personal factors, inadequate knowledge, time limitation, lack of motivation, and inadequate cooking skills were identified as subthemes. Social and cultural barriers included two subthemes: immediate family influence and social norms, while environmental barriers included two subthemes: lack of access to healthy options and high cost of healthy options. Conclusions &amp; Recommendations: Study findings provide important insights into challenges and perceived barriers to healthy eating, which highlight the need for further research based on barrier profiles to design and develop more attractive and realistic community prevention programs for healthy eating.

Cardiometabolic Patient-Related Factors Influencing the Adherence to Lifestyle Changes and Overall Treatment: A Review of the Recent Literature.

It is well acknowledged that most of the modifiable risk factors for Cardiovascular Diseases (CVDs) can be averted through lifestyle modifications beyond medication adherence. This review aims to critically evaluate the cardiometabolic (CM) patient-related factors that influence the adherence to lifestyle changes studied alone and/or in combination with medication. A comprehensive literature search of PubMed articles from 2000 to 2023 retrieved 379 articles. After removing the articles which were not relevant, a total of 28 cross-sectional studies was chosen (12 qualitative, and 16 quantitative). The findings confirmed that five groups of factors influence patients' adherence to overall treatment: (1) health beliefs, knowledge, and perceptions regarding the risks and challenges of disease and medication intake along with adherence process perceptions; (2) self-concept; (3) emotions; (4) patient-healthcare providers relationship/communication and (5) social and cultural interactions. It is worth mentioning that cultural issues, such as culinary particularities, ethnic identity, social life as well as patients' skills and abilities, play a profound role in the effectiveness of the recommended lifestyle modifications beyond the aforementioned common factors. The need for clear-cut culturally adapted guidelines along with personalized advice from physicians is imperative as it could improve patients' self-efficacy. These socio-psychological factors should be seriously considered as a means to increase the effectiveness of future community prevention programs.

Proceedings from the Second Medical Summit on Firearm Injury Prevention, 2022: Creating a Sustainable Healthcare Coalition to Advance a Multidisciplinary Public Health Approach.

Proceedings from the Second Medical Summit on Firearm Injury Prevention, 2022: Creating a Sustainable Healthcare Coalition to Advance a Multidisciplinary Public Health Approach.

A scoping review of veteran suicide prevention programs in Native American communities and in the general population.

Suicide is a major public health problem that disproportionately impacts veterans in the general U.S. population. Recent analyses indicate that American Indian and Alaska Native (AI/AN) veterans may be two to three times as likely as non-Hispanic White veterans to experience suicidal ideation. Although suicide prevention programs have been successfully implemented for many at-risk populations, to our knowledge, none have been designed or implemented for AI/AN veterans. To address this gap, we conducted a scoping review of suicide prevention programs with the objective of identifying promising strategies and lessons learned to identify promising practices for preventing suicide among AI/AN veterans. We conducted two parallel literature searches-a review of suicide prevention programs for the general U.S. adult population and AI/AN communities. We rated programs on 16 criteria, covering five domains-best practices in suicide prevention, U.S. Department of Veterans Affairs (VA) Office of Rural Health Promising Practice criteria, cultural fit, care coordination, and outcomes. Our findings indicate that many of the VA evidence-based or best practice programs are available system-wide, but none have been tailored for AI/AN veterans or the communities in which they live. Conversely, we found that many culturally specific programs implemented in AI/AN communities were rarely disseminated beyond tribal land and none were specifically developed for veterans. Based upon these findings, and to advance suicide prevention programs for AI/AN veterans, we propose a suicide prevention model that builds upon existing VA infrastructure to disseminate best practices to AI/AN communities and integrate tribal-specific cultural approaches to suicide prevention. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

School-based obesity prevention programs in rural communities: a scoping review.

The objective of this review was to examine existing literature and conceptually map the evidence for school-based obesity prevention programs implemented in rural communities, as well as identify current gaps in the literature. Pediatric obesity is a significant public health condition worldwide. Rural residency places children at increased risk of obesity. Schools have been identified as an avenue for obesity prevention in rural communities. We considered citations focused on children (5 to 18 years of age) enrolled in a rural educational setting. We included obesity prevention programs delivered in rural schools that focused on nutrition or dietary changes, physical activity or exercise, decreasing screen time, or combined nutrition and physical activity that aimed to prevent childhood obesity. We included all quantitative, qualitative, and mixed methods research designs, as well as text and opinion data. A search was conducted of published and unpublished studies in English from 1990 through April 2020 using PubMed, CINAHL Complete, ERIC, Embase, Scopus, Academic Search Premier, Cochrane Register of Controlled Trials, and ClinicalTrials.gov. Gray literature was also searched. After title and abstract review, potentially relevant citations were retrieved in full text. The full texts were assessed in detail against the inclusion criteria by 2 independent reviewers. Included citations were reviewed and data extracted by 2 independent reviewers and captured on a spreadsheet targeting the review objectives. Of the 105 studies selected for full-text review, 72 (68.6%) were included in the final study. Most of the studies (n = 50) were published between 2010 and 2019 and were conducted in the United States (n = 57). Most studies included children in rural elementary or middle schools (n = 57) and targeted obesity prevention (n = 67). Teachers implemented the programs in half of the studies (n = 36). Most studies included a combination of physical activity and nutrition components (n = 43). Other studies focused solely on nutrition (n = 9) or physical activity (n = 9), targeted obesity prevention policies (n = 9), or other components (n = 8). Programs ranged in length from weeks to years. Overall, weight-related, physical activity-specific, and nutrition-specific outcomes were most commonly examined in the included citations. Obesity prevention programs that focused on a combination of physical activity and nutrition were the most common. Multiple outcomes were examined, but most programs included weight-specific and health behavior-specific outcomes. The length and intensity of rural school-based obesity prevention programs varied. More research examining scientific rigor and specific outcomes of rural school-based obesity prevention programs is needed.

Analysis of Public Health Centre Financing using the District Health Account (DHA) Model in Karangasem District, Bali, Indonesia

Background and purpose: Health financing aspects of the public health centres (PHC) may influence the achievement of PHC’s programs and its minimum service standards (SPM). The District Health Account (DHA) is a model used to describe and evaluate health financing at the PHC level. The purpose of this study was to analyze health financing mechanism from both the government and national health insurance in the Karangasem District using the DHA Model. Methods: This study was an evaluation research with a case study approach using the DHA Model. Evaluations were carried out at two PHC, Manggis II PHC and Abang I PHC, between March and April 2018. Data were collected from the Karangasem District Health Office and the PHCs. These include PHC realization data, report on program achievements and SPM. The research instrument used for the data collection and analysis was the DHA extraction form and pivot table which includes information on cost sources, financing managers, service providers, functions, programs, types of activities, budget lines, levels of activities and beneficiaries. Results: We found the source of budget in both PHC was dominated by the district budget (APBD) and the national budget (APBN). The institutions which manage the budget and provide service were predominantly the Health Office and PHC. The most frequent financing functions was for governance and administration, while the largest types of activities covered was the indirect activities. Budget spending for operational costs was higher than for maintenance and investment. Realization of the activity for community program efforts (UKM) and prevention program (UKP) was lower than for the capacity building program. Conclusion: The DHA model was able to identify patterns of health budget allocation by health agencies. The use of the DHA model to analyze health financing should be adopted routinely in order to provide evaluation reports for health agencies at the district level.

The knowledge, attitude and practice of community people on dengue fever in Central Nepal: a cross-sectional study

BackgroundSince 2006, Nepal has experienced frequent Dengue fever (DF) outbreaks. Up to now, there have been no knowledge, attitude and practice (KAP) studies carried out on DF in Nepal that have included qualitative in-depth and quantitative data. Thus, we aimed to explore and compare the KAP of people residing in the lowland (< 1500 m) and highland (> 1500 m) areas of Nepal.MethodsA cross-sectional mixed-method study was conducted in six districts of central Nepal in September–October 2018 including both quantitative (660 household surveys) and qualitative data (12 focus group discussions and 27 in-depth interviews). The KAP assessment was executed using a scoring system and defined as high or low based on 80% cut-off point. Logistic regression was used to investigate the associated factors, in quantitative analysis. The deductive followed by inductive approach was adopted to identify the themes in the qualitative data.ResultsThe study revealed that both the awareness about DF and prevention measures were low. Among the surveyed participants, 40.6% had previously heard about DF with a significantly higher number in the lowland areas. Similarly, IDI and FGD participants from the lowland areas were aware about DF, and it’s associated symptoms, hence they were adopting better preventive practices against DF. The findings of both the qualitative and quantitative data indicate that people residing in the lowland areas had better knowledge on DF compared to people in highland areas. All IDI participants perceived a higher chance of increasing future dengue outbreaks due to increasing temperature and the mobility of infected people from endemic to non-endemic areas. The most quoted sources of information were the television (71.8%) and radio (51.5%). Overall, only 2.3% of the HHS participants obtained high knowledge scores, 74.1% obtained high attitude scores and 21.2% obtained high preventive practice scores on DF. Among the socio-demographic variables, the area of residence, educational level, age, monthly income, SES and occupation were independent predictors of knowledge level, while the education level of the participants was an independent predictor of the attitude level.ConclusionsOur study found a very low level of knowledge and insufficient preventive practices. This highlights an urgent need for extensive dengue prevention programs in both highland and lowland communities of Nepal.

Social Vulnerability and COVID-19: Changes in Trauma Activations at a Safety-Net Hospital.

IntroductionFollowing the declaration of the COVID-19 pandemic, there were reports of decreased trauma hospitalizations, although violent crime persisted. COVID-19 has had the greatest impact on minoritized and vulnerable communities. Decreases in traumatic events may not extend to these communities, given pandemic-related socioeconomic and psychological burdens that increase the risk of exposure to trauma and violence.Materials and methodsThis was a retrospective cohort study (n = 1634) of all trauma activations presenting to our institution January 1, 2020 to May 31, 2020, and same time periods in 2018 and 2019. Census tracts and associated Social Vulnerability Index quartiles were determined from patient addresses. Changes in trauma activations pre and post Massachusetts’ state-of-emergency declaration compared to a historical control were analyzed using a difference-in-differences methodology.ResultsWeekly all-cause trauma activations fell from 26.44 to 8.25 (rate ratio = 0.36 [0.26, 0.50]) postdeclaration, with significant difference-in-differences compared to a historical control (P < 0.0001). Nonviolent trauma activations significantly decreased from 21.11 to 5.17 after the declaration (rate ratio = 0.27 [0.37, 0.91]; P < 0.0001), whereas there was no significant decrease in violent injury (5.33 to 3.08 rate ratio = 0.69 [0.39, 1.22]; P = 0.20). Stratified by vulnerability, the most vulnerable quartile had an increased proportion of all-cause trauma postdeclaration and had no decrease in violent trauma activations following the declaration compared to the historical control (rate ratio = 0.84 [0.38-1.86]; P = 0.67).ConclusionsThe state-of-emergency declaration was associated with significant decreases in overall trauma, to a greater extent in nonviolent injuries. Among those living in the most socially vulnerable communities, there was no decrease in violent trauma. These findings highlight the need for violence and injury prevention programs in vulnerable communities, particularly in times of crisis.

Strengthening Communities: A Qualitative Assessment of Opportunities for the Prevention of Adverse Childhood Experiences in the Wake of the Opioid Crisis.

The opioid crisis is a significant challenge for health and human service systems that serve children, youth, and families across the United States. Between 2000 and 2017, the number of foster care entries, a type of adverse childhood experience (ACE), attributable to parental drug use increased by 147%. Nevertheless, there is variation in the burden of opioid overdose and foster care rates across the U.S., suggesting community supports and systems to support families affected by substance use also vary. This qualitative study sampled communities experiencing high and low rates of overdose mortality and foster care entries (i.e., a qualitative comparison group) to better understand what might protect some counties from high overdose mortality and foster care entries. The sample included six counties from three states that were selected based on their rates of opioid overdose mortality and foster care entries. Using purposive sampling within counties, interview and discussion group participants included multi-sector community partners, parents whose children had been removed due to parental substance use, and caregivers caring for children who had been removed from their homes. Across all counties, prevention was not front-of-mind. Yet, participants from communities experiencing high rates of overdose mortality and foster care entries identified several factors that might help lessen exposure to substance use and ACEs including more community-based prevention services for children and youth. Both parents and caregivers across all communities also described the need for additional supports and services. Participants also described the impact of COVID-19 on services, including greater utilization of mental health and substance use treatment services and the challenges with engaging children and youth on virtual platforms. The implications for prevention are discussed, including the need to encourage primary prevention programs in communities.

Migration in Namibia and its association with HIV acquisition and treatment outcomes.

BackgroundIn the 21st century, understanding how population migration impacts human health is critical. Namibia has high migration rates and HIV prevalence, but little is known about how these intersect. We examined the association between migration and HIV-related outcomes using data from the 2017 Namibia Population-based HIV Impact Assessment (NAMPHIA).Methods and findingsThe NAMPHIA survey selected a nationally representative sample of adults in 2017. All adults aged 15–64 years were invited to complete an interview and home-based HIV test. Recent infection (<130 days) was measured using HIV-1 LAg avidity combined with viral load (>1000 copies/mL) and antiretroviral analyte data. Awareness of HIV status and antiretroviral use were based on self-report and/or detectable antiretrovirals in blood. Viremia was defined as having a viral load ≥1000 copies/mL, including all participants in the denominator regardless of serostatus. We generated community viremia values as a weighted proportion at the EA level, excluding those classified as recently infected. Significant migrants were those who had lived outside their current region or away from home >one month in the past three years. Recent cross-community in-migrants were those who had moved to the community <two years ago. Separate analyses were done to compare significant migrants to non-migrants and recent cross-community in-migrants to those who in-migrated >two years ago to determine the association of migration and timing with recent infection or viral load suppression (VLS). All proportions are weighted. Of eligible adults, we had HIV results and migration data on 9,625 (83.9%) of 11,474 women and 7,291 (73.0%) of 9,990 men. Most respondents (62.5%) reported significant migration. Of cross-community in-migrants, 15.3% were recent. HIV prevalence was 12.6% and did not differ by migration status. Population VLS was 77.4%. Recent cross-community in-migration was associated with recent HIV infection (aOR: 4.01, 95% CI 0.99–16.22) after adjusting for community viremia. Significant migration (aOR 0.73, 95% CI: 0.55–0.97) and recent cross-community in-migration (aOR 0.57, 95% CI: 0.35–0.92) were associated with lower VLS, primarily due to lack of awareness of HIV infection. The study was limited by lack of precise data on trajectory of migration.ConclusionsDespite a high population-level VLS, Namibia still has migrant populations that are not accessing effective treatment for HIV. Targeting migrants with effective prevention and testing programs in communities with viremia could enable further epidemic control.

Development of a Tribally-led Gardening Curriculum for Indigenous Preschool Children: The FRESH Study

Development of a Tribally-led Gardening Curriculum for Indigenous Preschool Children: The FRESH Study

Modeling the Marked Presence-Only Data: A Case Study of Estimating the Female Sex Worker Size in Malawi

Certain subpopulations like female sex workers (FSW), men who have sex with men (MSM), and people who inject drugs (PWID) often have higher prevalence of HIV/AIDS and are difficult to map directly due to stigma, discrimination, and criminalization. Fine-scale mapping of those populations contributes to the progress toward reducing the inequalities and ending the AIDS epidemic. In 2016 and 2017, the PLACE surveys were conducted at 3290 venues in 20 out of the total 28 districts in Malawi to estimate the FSW sizes. These venues represent a presence-only dataset where, instead of knowing both where people live and do not live (presence–absence data), only information about visited locations is available. In this study, we develop a Bayesian model for presence-only data and utilize the PLACE data to estimate the FSW size and uncertainty interval at a -km resolution for all of Malawi. The estimates can also be aggregated to any desirable level (city/district/region) for implementing targeted HIV prevention and treatment programs in FSW communities, which have been successful in lowering the incidence of HIV and other sexually transmitted infections. Supplementary materials for this article, including a standardized description of the materials available for reproducing the work, are available as an online supplement.

A Meta-Analytic Review of Emotion Regulation Focused Psychosocial Interventions for Adolescents.

Emotion regulation (ER) is the ability to monitor, evaluate, and modify one's emotional responses to be appropriate for environmental demands. Poor ER has been considered a transdiagnostic risk factor for a range of internalizing and externalizing disorders and overall decreased well-being in adolescents. A range of evidence-based interventions exist which may improve ER. However, much of the intervention research to date does not include a measure of ER to assess change pre and post treatment, with limited information about the efficacy of these interventions in youth across a range of sample types. There is a clear need for a comprehensive review of the literature examining ER-focused interventions in adolescents with a wide range of presenting disorders. A literature search was originally conducted in January 2020 and an updated search was conducted in February 2021 which elicited 1245 articles, of which 605 were duplicates and were removed. Abstracts of the remaining 640 articles were screened with 121 articles being reviewed in full. Of note, 16 additional articles were identified through references and other sources during this process and were also included in the full review. Of the 137 articles reviewed in full, 41 studies were ultimately included in the present review. The present paper provides a descriptive review of intervention approaches and findings from community prevention programs, programs for war-affected youth, programs for clinical populations, and programs for incarcerated and delinquent adolescents. The overall pooled effect was significantly different from zero based on the pre/post effects [Hedge's g = 0.29, 95% CI (0.22, 0.36)] and the intervention/control effects [Hedge's g = 0.19, 95% CI (0.06-0.32)]. Although neither sex nor age significantly accounted for heterogeneity in effect sizes, there were significant findings for population type (clinical vs. community), with community samples having significantly lower effect sizes on average. Impacts of the different ER measures used and significant methodological variability (e.g., use of control groups, length of intervention) across included studies are discussed. Implications and suggestions for future research are reviewed, specifically, that additional understanding of moderators of effects are needed and that measures used to assess change in ER, both dysregulation and adaptive skill use, may need to more directly align with the intervention's focus and the strategies taught as part of the intervention.

Sustaining suicide prevention programs in American Indian and Alaska Native communities and Tribal health centers.

Background:Research on sustaining community-based interventions is limited. This is particularly true for suicide prevention programs and in American Indian and Alaska Native (AIAN) settings. Aiming to inform research in this area, this paper sought to identify factors and strategies that are key to sustain suicide prevention efforts in AIAN communities.Methods:We used a modified Nominal Group Technique with a purposeful sample of N = 35 suicide prevention research experts, program implementors and AIAN community leaders to develop a list of prioritized factors and sustainability strategies. We then compared this list with the Public Health Program Capacity for Sustainability Framework (PHPCSF) to examine the extent the factors identified aligned with the existing literature.Results:Major factors identified included cultural fit of intervention approaches, buy in from local communities, importance of leadership and policy making, and demonstrated program success. Strategies to promote these factors included partnership building, continuous growth of leadership, policy development, and ongoing strategic planning and advocacy. All domains of the PHPCF were representative, but additional factors and strategies were identified that emerged as important in AIAN settings.Conclusions:Sustaining effective and culturally informed suicide prevention efforts is of paramount importance to prevent suicide and save lives. Future research will focus on generating empirical evidence of these strategies and their effectiveness at promoting program sustainability in AIAN communities.

Healthier Together: Co-design of a culturally tailored childhood obesity community prevention program for Māori & Pacific Islander children and families.

Children of Māori & Pacific Islander descent living in Australia have a greater prevalence of overweight/obesity and an increased risk of adverse health outcomes. This study aimed to co-design Healthier Together, a community-based, childhood overweight/obesity prevention program tailored to Māori & Pacific Islander cultures. Co-design involved a three-phase, iterative, participatory and experience-based process, guided by the Te Ara Tika: Guidelines for Māori Research Ethics to promote respect and equity. Following traditional oratory customs of Māori & Pacific Islander cultures, "talanoa" facilitated the collaborative program design with recruited Māori & Pacific Islander consumers, cultural advisors and health professionals. Co-design formulated program objectives, session plans, resources and evaluation tools. Co-design developed a 9-week community-based childhood overweight/obesity prevention program providing culturally tailored education across four themes: (a) nutrition (b) physical activity (c) positive parenting practices (d) culture and health. Strong community engagement developed a program highly tailored to the local Māori & Pacific Islander population. Co-design methodology promotes equity and inclusion of all stakeholders, acknowledges and caters to diversity and creates a medium for openness, respect and shared purpose. Community-led participatory approaches are pivotal to engaging and empowering communities to successfully improve health behaviours, particularly in tackling childhood overweight/obesity. SO WHAT?: Healthier Together is culturally significant to ensure relevance, effectiveness and sustainability. It is relevant and potentially adaptable to other priority populations across Australia and globally. Ultimately, the delivery of culturally tailored health care will contribute to a reduction in the health inequity experienced amongst priority populations.

Familiarity With and Use of Insufficient Evidence Findings From the Community Preventive Services Task Force

The Community Preventive Services Task Force (CPSTF) is an independent, nonfederal panel of experts that uses systematic reviews to develop recommendations about community preventive services and programs to improve population health. The CPSTF issues an insufficient evidence (IE) finding when the evidence is lacking, inconsistent, or has significant methodologic limitations. An IE finding indicates a need for more research.1 The NIH partners with the Centers for Disease Control and Prevention Community Guide Office to support the CPSTF in making evidence-based recommendations and identifying research gaps.

Analysis of Public Health Centre Financing using the District Health Account (DHA) Model in Karangasem District, Bali, Indonesia

Background and purpose: Health financing aspects of the public health centres (PHC) may influence the achievement of PHC’s programs and its minimum service standards (SPM). The District Health Account (DHA) is a model used to describe and evaluate health financing at the PHC level. The purpose of this study was to analyze health financing mechanism from both the government and national health insurance in the Karangasem District using the DHA Model.Methods: This study was an evaluation research with a case study approach using the DHA Model. Evaluations were carried out at two PHC, Manggis II PHC and Abang I PHC, between March and April 2018. Data were collected from the Karangasem District Health Office and the PHCs. These include PHC realization data, report on program achievements and SPM. The research instrument used for the data collection and analysis was the DHA extraction form and pivot table which includes information on cost sources, financing managers, service providers, functions, programs, types of activities, budget lines, levels of activities and beneficiaries.Results: We found the source of budget in both PHC was dominated by the district budget (APBD) and the national budget (APBN). The institutions which manage the budget and provide service were predominantly the Health Office and PHC. The most frequent financing functions was for governance and administration, while the largest types of activities covered was the indirect activities. Budget spending for operational costs was higher than for maintenance and investment. Realization of the activity for community program efforts (UKM) and prevention program (UKP) was lower than for the capacity building program.Conclusion: The DHA model was able to identify patterns of health budget allocation by health agencies. The use of the DHA model to analyze health financing should be adopted routinely in order to provide evaluation reports for health agencies at the district level.