Health Of Target Population Research Articles

Identifying Health Literacy Responsiveness Improvement Ideas in Danish Health Centers: Initial Testing of the OS! Approach.

Background:Health services hold a critical role in mitigating the effect of health literacy challenges. Several tools and approaches have been developed to support health organizations in responding to their target population's health literacy needs. One of these is the OS! approach, which is an adapted and less rigorous version of the Australian Organizational health literacy responsiveness tool (Org-HLR). In this study, we aimed to report on our initial testing of the OS! approach in two Danish health care settings.Brief description:The OS! aim to prompt and support the development of local organizational health literacy improvement ideas. The process consists of three consecutive workshops focusing on reflection, self-evaluation, and prioritization. For each workshop tools are provided to support implementation.Implementation:The OS! approach was tested in two Danish municipal health centers (Tårnby Health Centre and Frederiksberg Health Centre), where both staff members and leaders took part in the processes (N = 62 and N = 84). In Tårnby, the process was closely facilitated by the research team, while local managers was in charge of the implementation in Frederiksberg.Results:In both settings, the process succeeded in identifying a list of relevant prioritized action ideas aimed at improving local health literacy responsiveness. In both instances, leaders were able to integrate some of these ideas in action plans for the organizations nearby future.Lessons learned:We found the OS! approach effective in its aim to identify health literacy responsiveness improvement ideas and based on our experience also less arduous to implement than the Org-HLR. We also learned that good implementation of the OS! approach depends strongly on careful facilitation including thorough introduction of the concepts of health literacy, openness, and creativity in relation to local adaptions within the overall framework of the approach, and the consolidation of consistent leader support throughout the organization. [HLRP: Health Literacy Research and Practice. 2022;6(3):e232–e238.]Plain Language Summary:This study describes the initial testing of the OS! approach. The OS! approach is based on the Australian methodology “Org-HLR” and use a participatory approach to prompt and support the identification of local health literacy responsiveness improvement ideas in health care organizations. The article provides valuable experiences regarding local development of organizational health literacy in practice.

Direct and Indirect Determinants of Body Mass Index in Both Major Ethnic Groups Experiencing the Nutritional Transition in Cameroon.

In the context of rapid nutritional transitions in Africa, few studies have analyzed the etiology of obesity by considering the driver pathways that predict body mass index (BMI). The aim of this study is to innovatively identify these driver pathways, including the main sociodemographic and socioecological drivers of BMI. We conducted a rural–urban quantitative study in Cameroon (n = 1106; balanced sex ratio) to explore this issue. We recruited participants and reported several sociodemographic characteristics (e.g., marital status, socioeconomic status (SES), and ethnicity). We then assessed three main socioecological drivers of BMI (body weight perception, dietary intake, and physical activity) and conducted bioanthropometric measurements. We identified several driver pathways predicting BMI. In Cameroon, Bamiléké ethnicity, higher SES, being married, and older age had positive effects on BMI through overweight valorization and/or dietary intake. Accordingly, we found that being Bamiléké, married, and middle-aged, as well as having a higher SES, were factors that constituted at-risk subgroups overexposed to drivers of obesity. As such, this study highlights the necessity of investigating the complex driver pathways that lead to obesity. Therefore, better identification of the subgroups at risk for obesity will help in developing more targeted population health policies in countries where this burden is a major public health issue.

Black-White Inequities in Kidney Disease Mortality Across the 30 Most Populous US Cities.

To examine city-level kidney disease mortality rates and Black:White racial inequities for the USA and its largest cities, and to determine if these measures changed over the past decade. We used National Vital Statistics System mortality data and American Community Survey population estimates to calculate age-standardized kidney disease mortality rates for the non-Hispanic Black (Black), non-Hispanic White (White), and total populations for the USA and the 30 most populous US cities. We examined two time points, 2008-2013 (T1) and 2014-2018 (T2), and assessed changes in rates and inequities over time. Racial inequities were measured with Black:White mortality rate ratios and rate differences. Kidney disease mortality rates varied from 2.5 (per 100,000) in San Diego to 24.6 in Houston at T2. The Black kidney disease mortality rate was higher than the White rate in the USA and all cities studied at both time points. In T2, the Black mortality rate ranged from 7.9 in New York to 45.4 in Charlotte, while the White mortality rate ranged from 2.0 in San Diego to 18.6 in Indianapolis. At T2, the Black:White rate ratio ranged from 1.79 (95% CI 1.62-1.99) in Philadelphia to 5.25 (95% CI 3.40-8.10) in Washington, DC, compared to the US rate ratio of 2.28 (95% CI 2.25-2.30). Between T1 and T2, only one city (Nashville) saw a significant decrease in the Black:White mortality gap. The largest US cities experience widely varying kidney disease mortality rates and widespread racial inequities. These local data on racial inequities in kidney disease mortality can be used by city leaders and health stakeholders to increase awareness, guide the allocation of limited resources, monitor trends over time, and support targeted population health strategies.

Levels, trends and socio-demographic determinants of infant and under-five mortalities in and around slum areas of Dhaka city, Bangladesh

Infant and child mortality are often used to monitor the progress of national population health programs. The data for this study was collected from selected urban slums where icddr,b has maintained the Health and Demographic Surveillance System (HDSS). Using the HDSS database, 6,666 married women were selected and interviewed in 2018 to collect data on socioeconomic status, pregnancy history and safe motherhood practices. The study examined levels and trends of infant and under-five mortality for three periods: 1990–1999 (Period 1), 2000–2009 (Period 2), and 2010–2018 (Period 3) and examined socio-demographic differentials of infant and under-five mortality for Period 3. From Period 1 to Period 3, under-five mortality declined by 68.2%, with child mortality (1–4 years) declining more than infant mortality (84% vs. 65%). In the regression models for Period 3, infant and under-five mortality were higher for working than non-working mothers (infant: OR = 1.35*, CI: 0.98, 1.86; under-five: OR = 1.34*, CI: 0.99, 1.82), lower for girls than boys (infant: OR = 0.77*, CI: 0.57, 1.03; under-five: OR = 0.77*, CI: 0.58, 1.03), higher for small-size than normal/big-size babies (infant: OR = 4.11***, CI: 3.00, 5.64; under-five: OR = 3.68***, CI: 2.70, 5.02), higher for babies delivered vaginally than by caesarean section (infant: OR = 1.79**, CI: 1.14, 2.97; under-five: OR = 1.87***, CI: 1.21, 2.88), higher for babies delivered with complications than no complication (infant: OR = 2.16***, CI: 1.48, 3.15; under-five: OR = 2.21***, CI: 1.55, 3.18), and higher for babies born after a short (<24 months) birth interval (infant: OR = 1.71*, CI: 0.96, 3.05; under-five: OR = 1.63*, CI: 0.93, 2.86) than firstborns. While substantial progress has been made in reducing under-five and infant mortality, neonatal mortality have declined less slowly. Targeted population health interventions addressing the socio-demographic drivers of infant mortality, with a focus on the urban poor, will help Bangladesh achieve Sustainable Development Goal 3.

Association Between Area-Level Socioeconomic Deprivation and Diabetes Care Quality in US Primary Care Practices

Diabetes management operates under a complex interrelationship between behavioral, social, and economic factors that affect a patient's ability to self-manage and access care. To examine the association between 2 complementary area-based metrics, area deprivation index (ADI) score and rurality, and optimal diabetes care. This cross-sectional study analyzed the electronic health records of patients who were receiving care at any of the 75 Mayo Clinic or Mayo Clinic Health System primary care practices in Minnesota, Iowa, and Wisconsin in 2019. Participants were adults with diabetes aged 18 to 75 years. All data were abstracted and analyzed between June 1 and November 30, 2020. The primary outcome was the attainment of all 5 components of the D5 metric of optimal diabetes care: glycemic control (hemoglobin A1c <8.0%), blood pressure (BP) control (systolic BP <140 mm Hg and diastolic BP <90 mm Hg), lipid control (use of statin therapy according to recommended guidelines), aspirin use (for patients with ischemic vascular disease), and no tobacco use. The proportion of patients receiving optimal diabetes care was calculated as a function of block group-level ADI score (a composite measure of 17 US Census indicators) and zip code-level rurality (calculated using Rural-Urban Commuting Area codes). Odds of achieving the D5 metric and its components were assessed using logistic regression that was adjusted for demographic characteristics, coronary artery disease history, and primary care team specialty. Among the 31 934 patients included in the study (mean [SD] age, 59 [11.7] years; 17 645 men [55.3%]), 13 138 (41.1%) achieved the D5 metric of optimal diabetes care. Overall, 4090 patients (12.8%) resided in the least deprived quintile (quintile 1) of block groups and 1614 (5.1%) lived in the most deprived quintile (quintile 5), while 9193 patients (28.8%) lived in rural areas and 2299 (7.2%) in highly rural areas. The odds of meeting the D5 metric were lower for individuals residing in quintile 5 vs quintile 1 block groups (odds ratio [OR], 0.72; 95% CI, 0.67-0.78). Patients residing in rural (OR, 0.84; 95% CI, 0.73-0.97) and highly rural (OR, 0.81; 95% CI, 0.72-0.91) zip codes were also less likely to attain the D5 metric compared with those in urban areas. This cross-sectional study found that patients living in more deprived and rural areas were significantly less likely to attain high-quality diabetes care compared with those living in less deprived and urban areas. The results call for geographically targeted population health management efforts by health systems, public health agencies, and payers.

1049-P: Finding Equity: Utilizing Artificial Intelligence to Identify Social and Infrastructural Predictors of Diabetes Mortality in Florida

DM outcomes represent one of the largest avoidable cost burdens with opportunity for improvement in the U.S. health care system. Improving health equity in the context of DM will require targeted community improvements, infrastructure investments, and policy interventions that are designed to maximize the impact of resource allocation through the use of available data and computational resources. By using an Artificial Intelligence approach to evaluate over 2000 socio-economic and infrastructural predictors of DM mortality, this study used a specific series of modeling techniques to identify significant predictors without human selection and compare their predictive ability with all possible factors when passed through artificial neural networks. The final regression model using zip code and county level predictors had an R2 of 0.863. Significant predictors included: Population % White, Population % Householders, Population % Spanish spoken at home, Population % Divorced males, Population % With public health insurance coverage, Population % Employed with private health insurance coverage, Manufacturing-Dependent Designation, Low Education Designation, Population % Medicare Part A and B Female Beneficiaries, Number of Short Term General Hospitals with 50-99 Beds. Using a multi-layered perceptron to predict zip codes at risk the C-statistic for all 2000+ predictors was 0.7938 while the 13 selected predictors was 0.8232. This indicates that these factors are highly relevant for DM mortality in Florida. This process was completed without the need of human variable selection and indicates how AI can be used for informative precision public health analyses for targeted population health management efforts. Disclosure A. Cistola: None.

Population Health Rounds: A Novel Vehicle for Training in Population Medicine and Clinical Preventive Medicine.

Preventive medicine residents must train in population medicine (including analytics and population health) and clinical preventive medicine (including screening, behavioral counseling, and chemoprophylaxis). Yet, opportunities to perform both functions concurrently for the same population are scarce. Residents must also master the art of preventive medicine, but they often lack an established community of practice that provides a continuous forum to do so. This project explored Population Health Rounds as a novel vehicle to optimize preventive medicine residency training. Modeled after traditional medical rounds, Population Health Rounds consist of a 1-hour weekly meeting engaging preventive medicine residents and supervising attendings at Stony Brook Medicine in both population medicine and clinical preventive medicine concurrently, including patient case discussions and targeted population health analytics. Because of the pandemic, the rounds have predominantly focused on COVID-19 and its effects on the hospital employee population. In addition to providing direct patient care to COVID-19-positive and exposed employees, residents have analyzed data on this population and made recommendations to hospital leadership based on COVID-19's institutional epidemiology, including incidence, prevalence, and predictive factors. A formative qualitative survey of resident perceptions offers insights on the value and learning outcomes of this new model. Factors that may impact the implementation, sustainability, and feasibility of this model are discussed. The preventive medicine residency program is commissioned to address gaps in clinical preventive services for the patient-centered medical home tied to the sponsoring institution's family medicine practice. Additional plans are underway to expand the rounds to other clinical contexts, such as lifestyle medicine in the occupational setting, and for targeted populations, such as the underserved. Replication of the Population Health Rounds model is recommended to determine its effectiveness.

Abstract 4471: Patient-reported outcomes and emergency department (ED) visits among gastrointestinal (GI) cancer patients prescribed anti-CTLA4/PD-1/L-1 antibody immunotherapy

Abstract Introduction: Leveraging electronic Patient Reported Outcomes (ePRO) improves cancer care delivery by reducing ED visits/hospitalizations and increasing overall survival. Yet little is known patient-reported outcomes or association with ED visits outcomes following immunotherapy. Here, we describe systematic ePRO collection using 15 core symptoms via the validated Patient Reported Outcomes - Common Terminology Criteria for Adverse Events (PRO-CTCAE) tool among pts prescribed anti-CTLA4/PD-1/L-1 antibody immunotherapy for GI cancer. Methods: We previously demonstrated feasibility of an electronic health record (EHR)-embedded ePRO collection via iPads for nearly 70% of new and established patients across Dana-Farber Cancer Institute ambulatory oncology practices. ePRO is deployed once weekly to established patients at home via the EHR patient portal or in clinic via tablet. Patient responses are scored using an algorithm, scaled 0-3, with scores of 3 indicating moderate/severe symptomatic adverse events (SAEs; equivalent to CTCAE grade 3+). We examined pt/disease/immunotherapy treatment characteristics, symptom burden at baseline, SAEs for pts prescribed Pembrolizumab, Nivolumab, Atezolizumab, Ipilimumab, Durvalumab, or Avelumab between January 2018 - August 2019. Exploratory analysis include frequency of ED visits at 30/60/90/120 days from immunotherapy start among subset reporting moderate/severe SAEs. Findings: Fifty-one (12.98%) of the 393 eligible pts prescribed immunotherapy used ePRO to report SAEs with median followup of 105 days (interquartile range 43-189). The summary distribution of SAEs across 15 PRO-CTCAE domains shows that moderate/severe SAEs reported were fatigue (19.61%), insomnia (11.76%), and general pain (21.57%); least frequently reported SAEs were fever/rash/vomiting (0%), and nausea (1.96%). In exploratory analysis, 111 (28%) patients had an ED visit, 37(9.40%) occurred within the first 90 days of treatment. Conclusions: We demonstrate proof-of-principle that ePRO implementation in routine practice is feasible, describes the distribution of patient-reported SAEs, and can be evaluated relative to key clinical outcomes such as ED utilization following immunotherapy. Further analysis will examine pt/disease/treatment characteristics predicting moderate/severe SAEs and inferior clinical outcomes. With increased response rates, we will leverage ePRO to develop targeted population health management interventions for patients prescribed immunotherapy in ambulatory oncology practice. Citation Format: Nadine J. McCleary, Jessica Cleveland, Sunyi Zhang, Vivek Upadhyay, Michael Hassett. Patient-reported outcomes and emergency department (ED) visits among gastrointestinal (GI) cancer patients prescribed anti-CTLA4/PD-1/L-1 antibody immunotherapy [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4471.

The complex association of barriers and interest in internet-delivered cognitive behavior therapy for depression and anxiety: informing e-health policies through exploratory path analysis

Background Internet-delivered cognitive behavioral therapy (ICBT) provides critical remote access to mental health care to at-risk populations. However, to our knowledge, no investigation has been conducted to understand complex pathways through which barriers to care (i.e. structural, attitudinal and technological) correlate with patient interest in ICBT. Aim The objective of this study is to develop and test a pathway analysis framework using structural equation modeling to understand direct and mediating associations of barriers to care with interest in ICBT. Methods This cross-sectional observational study was conducted among adult (>18 years) urban and rural residents (n = 200) in Saskatchewan, Canada. An online survey assessed interest in ICBT, barriers to ICBT, demographics, and depression and anxiety symptoms. Utilizing structural equation modeling, a path analysis framework was developed. Results Path analysis results showed how associations between complex barriers and demographic variables correlate with interest in ICBT. For instance, the negative association of perceived financial concerns and life chaos on interest in ICBT was mediated by perceived access to care. Conclusion The findings identify specific barriers that could be addressed through targeted population health interventions to improve uptake of ICBT.

Targeted Population Health Utilizing Direct Referral to Home-Based Older Person Upstreaming Prevention Physical Therapy From a Community-Based Senior Center

Purpose: An older adult's ability to remain safe and active in the community is multifactorial and includes physical and social determinants. The purpose of this study is to describe outcomes of the Home-Based Older Person Upstreaming Prevention Physical Therapy program targeted toward older adults referred from one community senior center. Methods: Older adults identified as “at risk” for decline or becoming homebound were referred by senior center staff. Home-Based Older Person Upstreaming Prevention Physical Therapy is a 6-month in-home preventative program entailing 6 in-person and 3 telehealth visits administered by a physical therapist (PT). Wellness, cardiovascular health, social integration, and frailty metrics resulted in interventions inclusive of cardiovascular and balance exercises, home safety, and community reintegration. Results: Participants (n = 30) demonstrated significant improvements in: Timed Up and Go (P = .02), Four Stage Balance Test (P = .003), STEADI Fall Risk Level (P = .002), Home FAST Assessment (P = .001), self-reported fear of falling (P = .001), Modified Falls Efficacy Scale (P = .01), and a Health Behavior Questionnaire (physical activity [P = .03], fruit and vegetable consumption [P = .03], and recommended weight [P = .01]). Conclusion: Home-Based Older Person Upstreaming Prevention Physical Therapy provided early access to preventative PT services in the homes of older adults. Positive functional, environmental, fall risk, and wellness outcomes were achieved when leveraging direct referral partnerships between community senior centers and PTs.

Association of a Targeted Population Health Management Intervention with Hospital Admissions and Bed-Days for Medicaid-Enrolled Children

As the proportion of children with Medicaid coverage increases, many pediatric health systems are searching for effective strategies to improve management of this high-risk population and reduce the need for inpatient resources. To estimate the association of a targeted population health management intervention for children eligible for Medicaid with changes in monthly hospital admissions and bed-days. This quality improvement study, using difference-in-differences analysis, deployed integrated team interventions in an academic pediatric health system with 31 in-network primary care practices among children enrolled in Medicaid who received care at the health system's hospital and primary care practices. Data were collected from January 2014 to June 2017. Data analysis took place from January 2018 to June 2019. Targeted deployment of integrated team interventions, each including electronic medical record registry development and reporting alongside a common longitudinal quality improvement framework to distribute workflow among interdisciplinary clinicians and community health workers. Trends in monthly inpatient admissions and bed-days (per 1000 beneficiaries) during the preimplementation period (ie, January 1, 2014, to June 30, 2015) compared with the postimplementation period (ie, July 1, 2015, to June 30, 2017). Of 25 460 children admitted to the hospital's health system during the study period, 8418 (33.1%) (3869 [46.0%] girls; 3308 [39.3%] aged ≤1 year; 5694 [67.6%] black) were from in-network practices, and 17 042 (67.9%) (7779 [45.7%] girls; 6031 [35.4%] aged ≤1 year; 7167 [41.2%] black) were from out-of-network practices. Compared with out-of-network patients, in-network patients experienced a decrease of 0.39 (95% CI, 0.10-0.68) monthly admissions per 1000 beneficiaries (P = .009) and 2.20 (95% CI, 0.90-3.49) monthly bed-days per 1000 beneficiaries (P = .001). Accounting for disproportionate growth in the number of children with medical complexity who were in-network to the health system, this group experienced a monthly decrease in admissions of 0.54 (95% CI, 0.13-0.95) per 1000 beneficiaries (P = .01) and in bed-days of 3.25 (95% CI, 1.46-5.04) per 1000 beneficiaries (P = .001) compared with out-of-network patients. Annualized, these differences could translate to a reduction of 3600 bed-days for a population of 93 000 children eligible for Medicaid. In this quality improvement study, a population health management approach providing targeted integrated care team interventions for children with medical and social complexity being cared for in a primary care network was associated with a reduction in service utilization compared with an out-of-network comparison group. Standardizing the work of care teams with quality improvement methods and integrated information technology tools may provide a scalable strategy for health systems to mitigate risk from a growing population of children who are eligible for Medicaid.

Access Clinic: A student-run clinic model to address gaps in the healthcare needs of the homeless population in Adelaide.

The average life expectancy of people who are homeless is approximately 20 years lower than the general population. Lack of access to healthcare is one of the key contributors to the increased morbidity and mortality. The aim of this article is to describe a student-run clinic that was established at a homeless shelter in Adelaide, Australia, to improve healthcare access for individuals who are homeless. By enhancing the target population's health literacy, the clinic functioned as a bridge between healthcare services and individuals experiencing homelessness who were disengaged from society. Such clinics, if encouraged, can foster a symbiotic relationship where students learn clinical medicine while gaining experience in providing healthcare to vulnerable individuals, and individuals who are homeless can access much-needed services in an environment they already engage with and feel safe in.

A Systems Thinking Approach for Targeted Population Health Management in the United States: Recommendations for Caregivers, Biotechnologists, Digital-technologists, and Policymakers

A Systems Thinking Approach for Targeted Population Health Management in the United States: Recommendations for Caregivers, Biotechnologists, Digital-technologists, and Policymakers

Determining Food-Insecure Families' Resource Access with Health System and Public Data.

Families' access to local food-insecurity (FI) resources differs. This study examines how health system and public data may be combined to identify limitations in community resources designed to address FI. We conducted a retrospective cohort study using electronic health record (EHR) data from nine practices that screened families for FI. Electronic health record data included demographic and clinical characteristics. Publicly available data included local socioeconomic and food resource information. We calculated the distance from each household to the nearest food pantry and determined the percentage of families who might have difficulty accessing resources. We demonstrate how health systems could merge these data sources to map where food-insecure families live, describe families' access to local resources, and identify regions where gaps in services exist. Health systems could use this approach to support households with FI and advocate for additional services in areas lacking resources in order to target population health efforts.

Gana Burrai: applying population data linkage to more accurately measure Aboriginal maternal and infant outcomes in the Goulburn Murray Region

IntroductionThe Australian 2016 census reported Aboriginal population of Goulburn Murray Region (GMR) as being 3% of the total GMR population is considered a significant under ascertainment. This is supported by the Freemantle et al population data linkage project that reported an underestimation of 51% of Aboriginal births in Hume region.&#x0D; Objectives and ApproachThe main objective of the Gana Burrai project was to undertake a Proof of Concept (POC) project to address the critical issue the under-ascertainment of data describing Aboriginal maternal and child health outcomes within the GMR. The PoC explored the feasibility of linking a number of population administrative datasets that included information describing Aboriginal babies born and mothers and fathers living in, the GMR. The PoC also enabled an evaluation of the cultural, organisational, practical and technical issues critical to the development of this comprehensive population data set. The linkage was undertaken using GRHANITETM privacy protecting software.&#x0D; ResultsPopulation data from seven administrative datasets describing birth years 2005-2015, representing 111862 records were successfully extracted. These data represented 37,338 patients. Following the linkage process, 28,016 patient records were successfully linked. The ever-Aboriginal concept was applied to the linked data. After linkage, there was a significant under ascertainment of Aboriginal births in records maintained by the Shire of Campaspe (16%), less so by Shire of Greater Shepparton (50%); Goulburn Valley Heath (92%), and Echuca Regional Health (86%) demonstrated a more complete ascertainment. However, the linkage showed a strong correlation of patient Indigenous identity collected by the shires’/hospitals’ and the mothers’/fathers’ chance of having a record at the Aboriginal Community Controlled Health Organisations. Selected birth outcomes were also analysed and will be reported.&#x0D; Conclusion/Implications1st Nations Governance combined with a privacy-protecting linkage model underpinned PoC ensuring strong community trust, engagement and control. It is 1st time such extensive data-linkage has been achieved demonstrating feasibility in developing a comprehensive dataset with the potential for evidence-based, targeted population health initiatives to be developed, implemented and evaluated.

Targeted Population Health Management for Under 55-Year-Olds Qualifying for LTC Services.

Targeted Population Health Management for Under 55-Year-Olds Qualifying for LTC Services.

Going beyond the vertical: leveraging a national HIV quality improvement programme to address other health priorities in Haiti.

Although the central role of quality to achieve targeted population health goals is widely recognized, how to spread the capacity to measure and improve quality across programmes has not been widely studied. We describe the successful leveraging of expertise and framework of a national HIV quality improvement programme to spread capacity and improve quality across a network of clinics in HIV and other targeted areas of healthcare delivery in rural Haiti.The work was led by Zamni LaSante, a Haitian nongovernment organization and its sister organization, Partners In Health working in partnership with the Haitian Ministry of Health in the Plateau Central and Lower Artibonite regions in 12 public sector facilities.Data included routinely collected organizational assessments of facility quality improvement capacity, national HIV performance measures and Zamni LaSante programme records.We found that facility quality improvement capacity increased with spread from HIV to other areas of inpatient and outpatient care, including tuberculosis (TB), maternal health and inpatient services in all 12 supported healthcare facilities. A significant increase in the quality of HIV care was also seen in most areas, including CD4 monitoring, TB screening, HIV treatment (all P < 0.01) and nutritional assessment and prevention of mother-to-child transmission (both P < .05), with an increase in average facility performance from 39 to 72% (P < .01).In conclusion, using a diagonal approach to leverage a national vertical programme for wider benefit resulted in accelerated change in professional culture and increased capacity to spread quality improvement activities across facilities and areas of healthcare delivery. This led to improvement within and beyond HIV care and contributed to the goal of quality of care for all.

Involving the Target Community in Health Education Planning: The Community Network Strategy

Abstract Health educators recognize the value of involving the community in needs assessment and planning activities but have difficulty identifying and involving people who truly reflect the target population's health perspective, particularly in disadvantaged and underserved communities. This article describes the Community Network Strategy (CNS), a technique enabling health educators to systematically penetrate successive layers of the community to find citizens who reflect the program's intended users. In a test of the CNS's utility, it was used to recruit women for four needs assessment focus groups for a mammography program in a low income, rural area. The CNS was consistently able to identify women who were socioeconomically disadvantaged and medically underserved, well-removed from the community's service structure, showed a range of demographic characteristics, and reflected important variations in the target communities' perceptions regarding mammograms. The strategy also elicited a high degree ...

Development of a transcultural health education program for the Hmong.

CNSs face unique opportunities and challenges in meeting the health care needs of culturally diverse populations. As an education consultant involved in the development and implementation of a transcultural health education program, a CNS is required to have expert knowledge of the target population's health beliefs, values, and practices as well as knowledge of their language, level of literacy, and traditional teaching-learning styles. A critical consideration includes the use of a pluralistic model of education that addresses both the implicit and explicit conditions of learning and education. This paper describes the model and its application in the development and implementation of a health education program for the Hmong. The transcultural education process is examined and analyzed for appropriateness and effectiveness.