Trained Community Members Research Articles

A rural ambulance service in Northern Togo improves access to emergency care for women with obstetric complications.

Maternal mortality remains high in sub-Saharan Africa, with little progress made in the last 20 years. The provision of emergency obstetric care has been shown to have the greatest effect in reducing maternal mortality in countries with high maternal mortality ratios, especially when paired with an emergency transport service. Integrate Health has partnered with the Togolese Ministry of Health to improve maternal and child health via the integration of a free ambulance service into a pre-existing primary care model. In this study, we aim to describe the implementation of this service and assess its effectiveness on access to emergency obstetric care by estimating its coverage of women with obstetric complications. This is a retrospective cross-sectional study using routinely collected data from ambulance logbooks. The study was restricted to pregnant or postpartum woman in four districts of Northern Togo. For each patient transported, the variables collected included date of transport, destination, patient information, kilometres travelled, and reason for transport. Complicated obstetric cases were defined by reason for transport and included maternal haemorrhage, complicated birth, and signs of danger. Estimated coverage of major obstetric complications was calculated using population estimates per fiscal year, the birth rate (3.7%) in Togo, and the assumption that 15% of pregnant women will have a complication. Between July 2020 and June 2023, there were 2926 maternal patients transported by the ambulance service. Of these, 1030 were reported as complicated obstetric cases. Estimated coverage of obstetric complications increased over time and as the programme expanded, from 18% in 2020 to 35.7% in 2021, and 66.5% in 2022. Our findings demonstrate that implementing a rural ambulance service in a region with historically high maternal mortality rates may improve maternal access to emergency obstetric care. The success of our ambulance service was likely due to the fact that it is free, available 24/7, easily accessible, operated by trained staff and community members, and integrated into a pre-existing primary care programme with well-resourced health care centres.

Transferability of vaccination interventions from a community perspective: One size does not fit all

Abstract Background Removing health system barriers to childhood vaccination is an urgent matter in the migrant community in Greece, the Turkish and Moroccan communities in the Netherlands, the Ukrainian minority in Poland, and the marginalized Roma community in Slovakia. The objective of this study was to select and adapt potentially transferable evidence-based interventions for HPV and MMR vaccine uptake in partnership with the underserved communities. Methods Using a participatory approach, we assessed transferability of six pre-selected interventions with the Population, Intervention, Environment and Transfer (PIET-T) models: All countries investigated two interventions with trained community members to support vaccination as health promoters. Greece and the Netherlands included a school-based vaccination program. The Netherlands added two interventions addressing providers’ HPV vaccine communication, and Slovakia a multilevel intervention. Results We identified barriers and facilitators for successful intervention transfer in each of the target contexts. The transferability analysis showed that an intervention with health promoters is potentially transferable with adaptations in all countries. Principles of trust in the educator, tailored and trustworthy information, help in navigating the health system for vaccination and easy access at no cost are transferable key elements in all contexts. Adaptations refer to the intervention elements that need to be tailored to specific contextual needs. School-based vaccination was nowhere transferable. Health provider training needs to be culturally sensitive and adapted to the Dutch system. The multilevel intervention in Slovakia is not fully transferable. Conclusions Participatory transferability analysis was essential for decision-making and intervention adaptation. All countries independently selected a health promoter intervention as having potential to remove the identified health system barriers in the respective context.

Tailoring intervention targeting HPV vaccination in marginalized Roma communities in Slovakia

Abstract Background Marginalized Roma communities (MRCs) are among underserved groups facing limited access to vaccination services and presumably low HPV vaccination rates. The most significant health system barriers to HPV vaccination include financial costs, lack of appropriate information and restricted capacities of healthcare providers. Two interventions identified as promising for implementation in the context of MRCs were discussed with a variety of stakeholders and community members to tailor intervention that would be well accepted and effective to increase HPV vaccination rates in MRCs. Methods The first intervention uses health promoters - trusted and trained community members to address cultural and language barriers and serve as a vital link between healthcare providers and community members. The second multilevel intervention is providing education, navigation, and vaccine access. Initial discussions were conducted with 23 stakeholders, and follow-up discussions were held with 16 stakeholders, including representatives of healthcare professionals, schools, local authorities, and community members. Results An intervention to be implemented in Slovakia focuses on the use of Roma health mediators who will provide parents and vaccine-eligible children (12-14 years old) from MRCs with information on HPV and HPV vaccination, invite them to educational sessions organized in community centres and at schools and navigate them through the vaccination process. The intervention also combines components such as videos and discussions with healthcare professionals, aligning with the needs and wishes of the target group. Conclusions This intervention will help to deliver reliable and understandable information on vaccination and enable people from MRCs to make informed decisions about vaccination. Roma health mediators will take the burden of providing information from overloaded healthcare providers and navigate community members through the vaccination process.

Empowering rural communities for effective larval source management: A small-scale field evaluation of a community-led larviciding approach to control malaria in south-eastern Tanzania

IntroductionLarval source management, particularly larviciding, is mainly implemented in urban settings to control malaria and other mosquito-borne diseases. In Tanzania, the government has recently expanded larviciding to rural settings across the country, but implementation faces multiple challenges, notably inadequate resources and limited know-how by technical staff. This study evaluated the potential of training community members to identify, characterize and target larval habitats of Anopheles funestus mosquitoes, the dominant vector of malaria transmission in south-eastern Tanzania. MethodsA mixed-methods study was used. First, interviewer-administered questionnaires were employed to assess knowledge, awareness, and perceptions of community members towards larviciding (N = 300). Secondly community-based volunteers were trained to identify and characterize aquatic habitats of dominant malaria vector species, after which they treated the most productive habitats with a locally-manufactured formulation of the biolarvicide, Bacillus thuringiensis var. israelensis. Longitudinal surveys of mosquito adults and larvae were used to assess impacts of the community-led larviciding programme in two villages in rural south-eastern Tanzania. ResultsAt the beginning of the program, the majority of village residents were unaware of larviciding as a potential malaria prevention method, and about 20 % thought that larvicides could be harmful to the environment and other insects. The trained community volunteers identified and characterized 360 aquatic habitats, of which 45.6 % had Anopheles funestus, the dominant malaria vector in the area. The preferred larval habitats for An. funestus were deep and had either slow- or fast-moving waters. Application of biolarvicides reduced the abundance of adult An. funestus and Culex spp. species inside human houses in the same villages, by 46.3 % and 35.4 % respectively. Abundance of late-stage instar larvae of the same taxa was also reduced by 74 % and 42 %, respectively. ConclusionThis study demonstrates that training community members to identify, characterize, and target larval habitats of the dominant malaria vectors can be effective for larval source management in rural Tanzania. Community-led larviciding reduced the densities of adult and late-stage instar larvae of An. funestus and Culex spp. inside houses, suggesting that this approach may have potential for malaria control in rural settings. However, efforts are still needed to increase awareness of larviciding in the relevant communities.

Training community members to deliver an intervention for substance use disorder: Overcoming implementation barriers in American Indian communities

IntroductionAlthough American Indian and Alaska Native (AI/AN) people have high rates of abstinence from alcohol and other drugs, there also is evidence of greater rates of substance use disorders (SUDs) in Native communities. Health disparities associated with substance use are compounded by inadequate access to evidence-based treatments (EBTs). Lack of mental health providers is one notable barrier to EBT implementation in rural AI reservation communities. Our Indigenous Recovery Planning (IRP) intervention merges cultural lessons and culturally adapted relapse prevention strategies to facilitate SUD recovery in the reservation environment. One key implementation strategy is training non-specialist community-based facilitators to deliver IRP, thereby increasing its acceptability and sustainability. This manuscript reports the facilitator training, supervision, and fidelity monitoring procedures used in our ongoing clinical trial of IRP. MethodThe study recruited four AI non-specialist providers from the community to serve as IRP facilitators. Initial training involved an introductory motivational interviewing workshop followed by a 2-day workshop in the IRP curriculum. Then we conducted an open trial of the 6-week intervention with weekly supervision meetings as part of the facilitator training process. During the open trial we also assessed participant and facilitator receptivity to the IRP intervention and pilot tested our fidelity monitoring protocol. ResultsThe initial training workshops provided facilitators with information they needed to understand the rationale behind IRP and determine whether the facilitator role was a good fit; however, additional training and supervision during the open trial was needed to ensure proper treatment delivery. Although participant and facilitator feedback ratings were positive, the open trial helped us identify revisions needed to improve our approach to facilitator training, supervision, and fidelity monitoring. We revised these procedures, and also developed a protocol to train new facilitators who join the study midstream. ConclusionThe open trial was an important aspect of the facilitator training process and helped our team identify several areas of improvement. Our approach to training, supervising, and monitoring community member facilitators may serve as an example of how to overcome one barrier to implementing evidence-based SUD treatments in rural reservation communities with few mental health professionals.

Exploring national and international experiences with community first responder models: protocol for a scoping review

IntroductionTimely arrival of emergency medical services (EMS) is pivotal for effective prehospital care, and efforts by EMS leaders and policymakers to reduce response times, especially in cardiac arrests responsible for...

The Evolving Nature of Threat and Violence Risk Assessment in College Counseling Centers

ABSTRACT This paper examines the historical and current contexts of threat assessment and violence risk in higher education, highlighting the evolving roles of college counseling centers in the threat assessment process for students displaying signs of concerning behaviors. Given research showing many college mental health professionals feel under-prepared for this work, we build foundational knowledge about the differing purposes of psychological evaluations and threat assessments, and provide recommendations for ways to continue to build and demonstrate understanding, competency and proficiency with threat assessments… Our review shares recent updates in the field regarding high-risk groups and the use of AI in assessment, and highlights the need for more attention to be given to training community members as well as counseling center staff and other members of campus teams involved in decision-making about students who threaten violence. We recommend the deliberate practice model of skill building to better prepare college mental health professionals when needing to respond under stress and pressure.

A co-design exemplar: how to align with community goals when developing data collection methods with communities from refugee backgrounds

Co-design in a research context is an approach that involves participants reflecting on their lived experience of a phenomenon to tailor research outcomes to their needs. It is empowering because it provides greater equity in the research process. However, minimal literature is available on ways to encompass co-design into research planning. This article aims to provide an exemplar of co-design research by describing how data collection methods and tools were developed in a participatory action research project through collaboration with community members with a lived refugee experience in Greater Brisbane, Australia. Eight people (aged 18 to 65) were recruited using convenience and purposive sampling, with four workshops held between January and April 2022. Workshops utilised co-design methods, including journey mapping, personas, brainstorming and experiential learning to capture the lived experience of accessing food, to collaboratively co-design data collection methods and tools, and to train community members as community researchers. Co-designing data collection methods ensured that community members with no research experience could contribute towards the design of culturally appropriate data collection tools. Future research in public health should embed co-design into research/intervention planning, execution and outcomes, and align research goals with community goals by drawing on lived experience.

Training & Community Involvement for Remote Housing Projects in Australia Northern Territory

Abstract—Construction of houses in remote communities faces a range of challenges, many of which would be reduced by the involvement of local community members during the construction. Remote housing demand is high and under-resourcing in existing houses impacts on the health of the occupants. This research investigates and evaluates ways to improve community engagement in remote housing projects. Builders with experience delivering remote housing projects were asked to provide insight relating to the potential training and involvement of community members during construction. It was found that builders have major challenges with work ethics, poor numeracy and literacy and language barrier in remote areas which hinder community engagement in remote projects. Some building techniques such as slab on ground and steel wall framing were found more effective for community engagement. Results also show that training of community members could be improved by setting benchmark goals to be achieved throughout a project. This means there is an opportunity for housing projects in remote communities to improve on essential training and employment through better involvement of local community members during construction, in turn this will lead to better maintenance and understanding of houses.

Community engagement around scrub typhus in northern Thailand: a pilot project.

Scrub typhus is highly endemic in northern Thailand yet awareness and knowledge are low. We developed a community engagement project to improve awareness in communities at risk of contracting scrub typhus. We conducted a series of engagement sessions with healthcare workers and community health volunteers so they would, in turn, engage with their communities. We evaluated our activities by assessing the increase in scrub typhus knowledge, using a series of Likert-scale items and open-ended questions. Three to 6 months after the sessions, participants were followed up to collect their experiences training community members. Of 134 participants who took part in eight sessions, 87.3% were community health volunteers. Disease knowledge increased substantially after the sessions and was well maintained for up to 5 mo. Satisfaction was high and, through participant feedback, engagement materials were improved to be more useful to the communities. People with higher education had higher scores and retention. Community engagement was shown to be an effective tool to develop and carry out health-promoting activities in a culturally and context-appropriate manner.

The Use of Health Equity Impact Assessments to Modify Evidence Based Strategies within Local Health Departments in North Carolina

Abstract: Background. Health equity impact assessments (HEIAs) inform the reduction of health inequities by evaluating programs or policies that affect target populations. Local health departments (LHD) receiving funding through the Improving Community Outcomes for Maternal and Child Health (ICO4MCH) Program conducted HEIAs for evidence-based strategies (EBSs). This paper describes the impact of HEIAs on the implementation of EBSs and highlights lessons learned during implementation of HEIA modifications. Methods. We conducted a content analysis using data from the HEIA Modification Tracker and focus groups to identify themes and lessons learned. Results. Fifteen HEIAs were conducted by five LHDs between 2016 and 2020. The most common modifications to EBS implementation were 1) increasing education and training for community members and 2) altering messaging mediums and language to reach intended audiences. Discussion. Health equity impact assessments serve as a systematic and tangible way to center health equity, reflect on past processes, and inform improvements.

HOME BLOOD PRESURE MEASUREMENT IN RURAL SUB-SAHARAN AFRICA

Objective: Self-home blood pressure (BP) measurement has been reported to be superior to office BP measurements (attended or unattended) in diagnosing hypertension. However, it is not readily available in rural sub-Saharan Africa (SSA) due to the cost of the measurement devices and the literacy it requires to correctly measure and record BP. Consequently, the diagnostic performance of self-home BP measurement in rural sub-Saharan Africa remains unclear. Trained community health workers (CHWs) with home BP measurement devices may improve the availability and use of these devices by providing and training community members to use them Design and method: We are conducting a cross-sectional study to determine the diagnostic performance of self-home BP measurement in identifying individuals with hypertension in rural Kenya and The Gambia. A random age-stratified random sample of 1250 participants aged 30 years and above from the Kilifi Health and Demographic Surveillance System and the Kiang West Demographic Surveillance System are being enrolled into the study. Trained CHWs avail the measurement devices to enrolled participants and train them to measure and record their BP for seven consecutive days. Primary data of BP measurements are then downloaded from the measurement devices. Additionally, participants undergo ambulatory BP monitoring (reference standard). Results: Recruitment is ongoing. We have enrolled and completed BP measurements for 154 participants, all from the Kenya study site (12% of the total sample). Of these 106 (69%) are female with an average age of 57 years (standard deviation 15 years). Based on home and ambulatory BP respectively, 49 (32%) and 66 (43%) of included participants are hypertensive. Of the included participants, 26 (17%) have masked hypertension and were not detected by home BP while 9(6%) are normotensive but considered hypertensive based on home BP. The preliminary sensitivity and specificity of self-home BP measurement is 0.61 (0.49, 0.72) and 0.90 (0.81, 0.95) respectively while its diagnostic odds ratio (DOR) is 13.5 (likelihood ratio positive 5.93 (3.10, 11.34)). Further analyses will be conducted when recruitment is complete. Conclusions: Self-home BP measurement has modest diagnostic utility in the general population in rural SSA.

Comparing Mediators and Moderators of Mental Health Outcomes from the Implementation of Group Problem Management Plus (PM+) among Venezuelan Refugees and Migrants and Colombian Returnees in Northern Colombia.

Colombia hosts the largest number of refugees and migrants fleeing the humanitarian emergency in Venezuela, many of whom experience high levels of displacement-related trauma and adversity. Yet, Colombian mental health services do not meet the needs of this population. Scalable, task-sharing interventions, such as Group Problem Management Plus (Group PM+), have the potential to bridge this gap by utilizing lay workers to provide the intervention. However, the current literature lacks a comprehensive understanding of how and for whom Group PM+ is most effective. This mixed methods study utilized data from a randomized effectiveness-implementation trial to examine the mediators and moderators of Group PM+ on mental health outcomes. One hundred twenty-eight migrant and refugee women in northern Colombia participated in Group PM+ delivered by trained community members. Patterns in moderation effects showed that participants in more stable, less marginalized positions improved the most. Results from linear regression models showed that Group PM+-related skill acquisition was not a significant mediator of the association between session attendance and mental health outcomes. Participants and facilitators reported additional possible mediators and community-level moderators that warrant future research. Further studies are needed to examine mediators and moderators contributing to the effectiveness of task-shared, scalable, psychological interventions in diverse contexts.

Development of mental health first-aid guidelines for a person after a potentially traumatic event: A Delphi expert consensus study in Argentina and Chile

BackgroundExposure to potentially traumatic events increases the risk of a person developing a mental disorder. Training community members to offer support to a person during and after a traumatic situation may help lower this risk. This study reports on the cultural adaptation of Australian mental health first aid guidelines for individuals exposed to a potentially traumatic event to the Chilean and Argentinian context.MethodsA Delphi expert consensus study was conducted with two panels of experts, one of people with lived experience of trauma (either their own or as a carer; n = 26) and another one of health professionals (n = 41). A total of 158 items, drawn from guidelines developed by Australian experts in 2019, were translated to Spanish and evaluated in a two-round survey process. The panellists were asked to rate each item on a five-point Likert scale; statements were included in the final guidelines if 80% of both panels endorsed the item as “essential” or “important”.ResultsConsensus was achieved on 142 statements over two survey rounds. A total of 102 statements were included from the English-language guidelines, and 40 locally generated statements were accepted in the second round. Local experts endorsed a larger number of items compared to their counterparts in Australia and emphasised the importance of acknowledging the first aider’s limitations, both personally and as part of their helping role. Additional items about working as a team with other first responders and considering helping the person’s significant others were endorsed by the local panellists.ConclusionsThe study showed a high level of acceptance of the original actions suggested for inclusion in the guidelines for Australia, but also a significant number of new statements that highlight the importance of the adaptation process. Further research on the dissemination of these guidelines into a Mental Health First Aid training course for Chile and Argentina is still required.

Male perspectives on intimate partner violence: A qualitative analysis from South Africa.

Intimate partner violence (IPV) affects one in four women globally and is more commonly enacted by men than women. Rates of IPV in South Africa exceed the global average. Exploring the background and context regarding why men use violence can help future efforts to prevent IPV. We explored adult men's perspectives of IPV, livelihoods, alcohol use, gender beliefs, and childhood exposure to abuse through a secondary analysis of qualitative interviews that were conducted in South Africa. The setting was a peri-urban township characterized by high unemployment, immigration from rural areas, and low service provision. We utilized thematic qualitative analysis that was guided by the social ecological framework. Of 30 participants, 20 were residents in the neighborhood, 7 were trained community members, and 3 were program staff. Men reported consumption of alcohol and lack of employment as being triggers for IPV and community violence in general. Multiple participants recounted childhood exposure to abuse. These themes, in addition to culturally prescribed gender norms and constructs of manhood, seemed to influence the use of violence. Interventions aimed at reducing IPV should consider the cultural and social impact on men's use of IPV in low-resource, high-IPV prevalence settings, such as peri-urban South Africa. This work highlights the persistent need for the implementation of effective primary prevention strategies that address contextual and economic factors in an effort to reduce IPV that is primarily utilized by men directed at women.

Emerging Trends in Worker-Cooperatives in a Changing World of Work: Implication for Community Development in Nigeria

Worker-cooperatives are emerging as organizational structures responding to the trends within the world of work, ranging from technological, economical to social trends. They have a specific democratic governance structure of management and members being the workers and they are also in charge of decisions making in the enterprise. As part of the trends in a changing world of work, worker-cooperatives use different spectrums of technologies for local and international work performance. They buy out or take over business organizations that are failing as a result of the financial and economic crisis and transform the business organizations into productive enterprises. They also generate employment for members and non-members, provide financial assistance to members and non-members at a reduced interest rate and help to train community members to be proficient in different fields of endeavour. Obviously, in the Nigerian society today, worker-cooperatives are agents of bringing development in urban settlements and rural communities.

How can asset-based approaches reduce inequalities? Exploring processes of change in England and Spain.

Initiatives to promote health and reduce inequalities in place-based communities have increasingly adopted asset-based approaches (ABAs). However, the processes through which such initiatives might reduce inequalities are not well understood, and evidence of their impact on health is still limited. This study aimed to understand how ABAs can impact practices, relationships and the redistribution of resources to reduce health inequalities in and betweenless advantaged neighbourhoods. Qualitative research was conducted in two settings (England and Spain) where similar asset-based initiatives, aimed at training community members to become health promoters, were being implemented. Data were collected using theory of change workshops, 120 hours of observations and semi-structured interviews with 44 stakeholders (trained community members, voluntary and community sector organizations' workers and health professionals). A thematic analysis informed by systems thinking was carried out. Three main processes of change were identified: first, 'enabling asset-based thinking' defined as supporting people to adopt a view that values their own resources and people's skills and expertise. Second, 'developing asset-based capacities', described as developing personal skills, knowledge, self-confidence and relationships underpinned by asset-based thinking. Finally, 'changing decision-making and wider health determinants through ABAs' referred to achieving changes in neighbourhoods through mobilizing the asset-based capacities developed. These processes were associated with changes at an individual level, with potential to contribute to reducing inequalities through supporting individual empowerment and social capital. However, contextual factors were found key to enable or hinder changes in the neighbourhoods and acted as barriers to processes of collective empowerment, thus limiting ABAs' impact on health inequalities.

Dynamics of malaria vector composition and Plasmodium falciparum infection in mainland Tanzania: 2017–2021 data from the national malaria vector entomological surveillance

BackgroundIn 2015, Tanzania National Malaria Control Programme (NMCP) established a longitudinal malaria vector entomological surveillance (MVES). The MVES is aimed at a periodical assessment of malaria vector composition and abundance, feeding and resting behaviours, and Plasmodium falciparum infection in different malaria epidemiological strata to guide the NMCP on the deployment of appropriate malaria vector interventions. This work details the dynamics of malaria vector composition and transmission in different malaria epidemiological strata.MethodsThe MVES was conducted from 32 sentinel district councils across the country. Mosquitoes were collected by the trained community members and supervised by the NMCP and research institutions. Three consecutive night catches (indoor collection with CDC light trap and indoor/outdoor collection using bucket traps) were conducted monthly in three different households selected randomly from two to three wards within each district council. Collected mosquitoes were sorted and morphologically identified in the field. Thereafter, the samples were sent to the laboratory for molecular characterization using qPCR for species identification and detection of P. falciparum infections (sporozoites). ELISA technique was deployed for blood meal analysis from samples of blood-fed mosquitoes to determine the blood meal indices (BMI).ResultsA total of 63,226 mosquitoes were collected in 32 district councils from January 2017 to December 2021. Out of which, 39,279 (62%), 20,983 (33%) and 2964 (5%) were morphologically identified as Anopheles gambiae sensu lato (s.l.), Anopheles funestus s.l., and as other Anopheles species, respectively. Out of 28,795 laboratory amplified mosquitoes, 13,645 (47%) were confirmed to be Anopheles arabiensis, 9904 (34%) as An. funestus sensu stricto (s.s.), and 5193 (19%) as An. gambiae s.s. The combined average entomological inoculation rates (EIR) were 0.46 (95% CI 0.028–0.928) for An. gambiae s.s., 0.836 (95% CI 0.138–1.559) for An. arabiensis, and 0.58 (95% CI 0.165–0.971) for An. funestus s.s. with variations across different malaria transmission strata. Anopheles funestus s.s. and An. arabiensis were predominant in the Lake and South-Eastern zones, respectively, mostly in high malaria transmission areas. Monthly mosquito densities displayed seasonal patterns, with two peaks following the rainy seasons, varying slightly across species and district councils.ConclusionAnopheles arabiensis remains the predominant vector species followed by An. funestus s.s. in the country. Therefore, strengthening integrated vector management including larval source management is recommended to address outdoor transmission by An. arabiensis to interrupt transmission particularly where EIR is greater than the required elimination threshold of less than one (< 1) to substantially reduce the prevalence of malaria infection.

Impact of the Brave Heart mental health intervention on the prevalence and severity of depression among young internally displaced persons in Northern Nigeria

IntroductionDepression is prevalent among internally displaced persons (IDPs). Yet, mental health services are scarce among IDPs in low-and-middle-income countries. This study assessed the effectiveness of a task-shifting based mental health intervention on the severity of depressive symptoms among young IDPs in Northern Nigeria. MethodsThis was quasi-experimental study design (one-group pre-test and post-test design). The Patient Health Questionnaire (PHQ-9) was used to assess the severity of Depression prior (and after) to the program implementation and 100 young IDPs aged 13–24 years who had mild to moderate Depression were the study participants. The Brave Heart intervention adopted a task-shifting approach where 20 trained community members provided mental health therapy sessions to the participants. Data analysis was done using SPSS version 26. Paired t-test was used to analyze the difference between the baseline and endline scores (p < 0.001). ResultsOut of the 83 young IDPs that completed the post-test assessment in this study, some (43.4%) were aged 20–24 years and 51.8% of them were males. There was a significant difference between the depression baseline and endline mean scores across the different age groups (p < 0.001), gender (p < 0.001), and level of education (p < 0.001). There was a significant difference between the overall depression mean score at the baseline and end-line levels (p = 0.001). ConclusionThe Brave Heart intervention was effective in reducing the severity of depression among young people living in IDP camps. There is a need for health stakeholders to adopt this program in other hard-to-reach communities where mental health services are scarce.

Knowledge and misconceptions of choking and first-aid procedures among Syrian adults: A cross-sectional study.

Choking is a critical emergency that occurs when foreign objects obstruct the airways. It commonly affects young children, older people, individuals with developmental disabilities, those with acquired or lifelong disability, and those with mental health conditions. Symptoms can vary, ranging from coughing to cyanosis. Our study aims to evaluate Syrian adults' knowledge of choking and their understanding of first-aid procedures. Specifically, we will assess the prevalence of misconceptions in order to train community members and increase their level of knowledge about first aid for choking. Ultimately, our goal is to reduce deaths resulting from this critical condition. This cross-sectional study aims to assess the knowledge and attitudes regarding choking among adults in Syria. The targeted population consists of Syrians aged between 18 and 45 years who reside in Syria. Data were collected through an online survey, disseminated via social media platforms from March to July 2022. Scores were computed to quantify levels of knowledge, with participants achieving a score of 16 or higher classified as having a high level of knowledge. The collected data were analyzed using descriptive statistics, Pearson's correlation coefficient, and chi-square tests. A total of 406 responded to the survey, with 246 (60.6%) scoring less than 16 points, indicating a low level of knowledge. Gender and place of residency were not correlated with knowledge level p = 0.249, p = 0.913, respectively). Participants employed in the medical field, those who had received training in first aid, and individuals with higher levels of education exhibited higher levels of knowledge. However, the level of knowledge was below expectations for these groups. There should be an increase in the availability of first-aid courses to the public and improvements in hands-on training for physicians and medical trainees.