Medical students' experience and learning outcomes of overseas community involvement project: a qualitative study.

BACKGROUND: Medical students in Singapore engage in short term medical missions, locally known as Overseas Community Involvement Projects (OCIPs). Little is known about the learning outcomes of an OCIP and how this complements their medical education back home. Understanding this can help the medical educators structure the OCIP to optimise its learning value. OBJECTIVES: This study aims to gain an in-depth understanding of the experiences and learning outcomes of the medical students who participated in the OCIP. METHODS: This was a qualitative study involving Singaporean students from one medical school travelling to Nepal. Data was collected from reflective journals, overall group reflections and two focus group discussions. The data was thematically analysed using the Accreditation Council for Graduate Medical (ACGME) core competencies for medical professionals. RESULTS: The data could be classified under various themes within the six domains of the ACGME framework. The study revealed themes of: humanism, socioeconomic and cultural determinants of health under the domain of patient care, application of medical knowledge, investigating and evaluating the needs of a population and feedback to drive improvement under the domain of practice-based learning and improvement, use of non-verbal cues and communicating across language barriers under the domain of interpersonal and communication skills, healthcare systems and delivery, resourcefulness and adaptability, health equity and accessibility under the domain of systems-based practice, ethics, role-modelling, teamwork and leadership skills, interprofessional skills and resilience under the domain of professionalism. Understanding the students' motivations, utilising reflections, and following the patients' journey facilitated attainment of these outcomes. CONCLUSIONS: This OCIP experience translated to learning outcomes aligned with the ACGME framework. There is great potential for the experiential learning from a well-structured OCIP to help with personal and professional development and global health education.

Promoting Late-Life Volunteering With Timebanking: A Quasi-Experimental Mixed-Methods Study in Hong Kong.

Background and Objectives: This study explores the impact of timebanking, where individuals earn time credits, nonmonetary currency, on promoting volunteerism among older adults. Research Design and Methods: This study employed a quasi-experimental design with 116 timebank group (TBG) participants and 114 comparison group (CG) participants from 2021 to 2022. TBG received time credits to exchange for rewards, while CG received no time credits (i.e., volunteering as usual). The intervention of timebanking lasted for 1 year. Volunteering behaviors were tracked via an app, and intentions to volunteer were assessed at baseline (T0), after 6 months (the midpoint of the intervention, T1), and after 12 months (the endpoint of the intervention, T2). The use of rewards by TBG participants was also recorded (e.g., for personal use or sharing with others). Furthermore, focus group interviews were conducted to understand how rewards influenced participants' volunteerism. Results: TBG had significantly higher weekly volunteer hours at T2 (ß = 1.37, p = .021) and increased intent to volunteer at T1 (ß = 0.54, p = .001) and T2 (ß = 0.51, p = .001) compared with CG. Participants using rewards personally volunteered more at T2 (ß = 2.09, p = .014), although sharing rewards with family and friends or donating rewards to others did not yield the same effect. The qualitative study suggested that a sense of feeling recognized generated by timebanking may encourage increased volunteering and that personal reward use enriched the volunteer experience, and individuals sharing rewards with family and friends experienced a sense of fulfillment and reinforcement of their prosociality. Discussion and Implications: Timebanking effectively encourages late-life volunteering. The study provides practical implications for promoting volunteering among older people.

Temporal and Racial/Ethnic Patterns of Social Engagement among Older Adults: Evidence from American Time Use Survey 2019 to 2022.

This study examines temporal and racial/ethnic patterns in social engagement among older adults from 2019 to 2022, using data from the American Time Use Survey (ATUS) for adults aged 60 and older (n = 13,605). Social engagement was operationalized as time spent on five activities in in-home and out-of-home settings. Descriptive analysis was used to characterize temporal trends of social engagement, and zero-inflated negative binomial regression was utilized to estimate year-specific racial/ethnic differences. Results indicate an initial decline in out-of-home social engagement, followed by a gradual recovery. Racial differences in social engagement became salient during the pandemic period. The evolving racial and ethnic patterns in social engagement underscore the challenges that Black and Hispanic older adults faced during the public health crisis. Understanding activity patterns specific to racial/ethnic groups has implications for targeted interventions, informing strategies to support Black, Hispanic, and other minoritized older adults in public health emergencies.

"It Made Me Feel Like a Person Again": Benefits of Meals on Wheels-Based Social Connection Programs.

Social isolation and loneliness are associated with negative health outcomes, and these outcomes are exacerbated among older adults who are homebound. To address this issue, Meals on Wheels programs increasingly provide social connection services to clients in addition to home-delivered meals. This descriptive qualitative study examines the impact of three types of social connection programs on the well-being of homebound older adult clients, as well as on the volunteers and staff members who deliver the programs. Thematic analysis of semi-structured interviews conducted with 117 clients, volunteers, and staff in six Meals on Wheels social connection programs across the United States indicated that program participation was associated with substantial benefits. Benefits included the development of supportive friendships, reduced feelings of loneliness, and an improved overall sense of well-being. Insights from this study may inform the development, expansion, and sustainability of social connection programs provided by community-based organizations.

Variations in Benefits of Intergenerational Tutoring in the "New Normal".

This study investigated the benefits and challenges of intergenerational tutoring in a post-pandemic context. We explored how the benefits of intergenerational tutoring vary among subgroups of volunteers-first-time tutors, male tutors, tutors who are caregivers, and tutors with moderate or severe loneliness. Older adult tutors (N = 319) were surveyed before and after the 2021-2022 school year, and the data were analyzed with structural equation multivariate regression and thematic analysis. Results indicated that while public health measures like mask-wearing posed challenges for some tutors, there were positive outcomes for tutors, especially first-time tutors, who experienced more health and well-being benefits, and tutors who are caregivers, who experienced improved civic attitudes towards public education. These results can help programs attract subgroups of volunteers who are likely to benefit the most, as well as attend to the unique challenges of pandemic-related policies.

Needs and Challenges for Volunteering in Rural Areas: Lessons Learned From a Survey of a Service Organization in Rural Michigan.

BACKGROUND AND OBJECTIVES: Volunteers are the foundation of social service agencies in rural communities, yet limited research exists on their needs and challenges. Motivated by the multidimensional older voluntarism sustainability framework, this study aims to understand (1) the characteristics of volunteers, (2) the relationships between volunteers' sense of community and their own aging and volunteer retention, and (3) the unique challenges faced by volunteers and volunteer-based agencies. RESEARCH DESIGN AND METHODS: This study uses a mixed-methods design. Data were gathered via telephone interviews (n = 76) and in-person focus groups (n = 14) from the volunteer pool of a nonprofit organization in rural Michigan. Descriptive and regression analyses were conducted to understand the characteristics of the volunteers. Thematic analysis was conducted to identify unique challenges faced by rural agencies and volunteers. RESULTS: Findings show that most volunteers were over 70, women, married, volunteered weekly or more, and were affiliated with multiple agencies. Volunteers with a stronger attachment to the community and higher self-perceptions of aging were likelier to continue and increase volunteering commitments. Due to the low population density in rural areas, volunteers were concerned about the heavy burden of volunteering, the lack of social connections with fellow volunteers, and the lack of active involvement in shaping the organization. DISCUSSION AND IMPLICATIONS: Results from the study shed light on the urgent need for creative and engaging volunteer recruitment and retention strategies to sustain older adults, service agencies, and communities in rural areas.

The Association Between Active Membership in Voluntary Organizations and Homonegativity.

OBJECTIVES:  Homonegativity adversely affects the health and well-being of homosexuals in society, making it vital to identify factors associated with it. This study investigates whether active membership in voluntary organizations correlates with homonegativity, examining how this varies by gender and age. METHODS:  Using the World Values Survey data (2017-2022) from 87,777 participants in 63 countries, we performed binary logistic regression to assess relationships between homonegativity and factors including socioeconomic status, demographics, and voluntary activity participation. RESULTS:  Our findings suggest that active membership in certain voluntary organizations correlates with homonegativity levels among both men and women across various age groups. Specifically, active participation in sports or recreational organizations, professional associations, art, music, or educational organizations, and humanitarian or charitable organizations was found to be negatively correlated with homonegativity in specific gender-age groups, albeit with varying degrees of association strength. CONCLUSION:  This study highlights the complex relationship between engagement in voluntary organizations and attitudes toward homosexuality, with significant differences observed across gender and age. While identifying a correlation rather than causation, this study suggests the importance of societal and community participation in fostering more tolerant views toward homosexuals. Furthermore, our analysis indicates that demographic and socioeconomic variables, the political freedom of the respondent's country, and the respondent's life satisfaction are also linked to homonegativity.

Volunteerism Addressing Environmental Disparities in Allergy (VAEDIA): The presidential initiative to combat environmental injustice in allergy and immunology-a Work Group Report of the AAAAI VAEDIA task force.

Many vulnerable people lose their health or lives each year as a result of unhealthy environmental conditions that perpetuate medical conditions within the scope of allergy and immunology specialists' expertise. While detrimental environmental factors impact all humans globally, the effect is disproportionately more profound in impoverished neighborhoods. Environmental injustice is the inequitable exposure of disadvantaged populations to environmental hazards. Professional medical organizations such as the American Academy of Allergy, Asthma & Immunology (AAAAI) are well positioned to engage and encourage community outreach volunteer programs to combat environmental justice. Here we discuss how environmental injustices and climate change impacts allergic diseases among vulnerable populations. We discuss pathways allergists/immunologists can use to contribute to addressing environmental determinants by providing volunteer clinical service, education, and advocacy. Furthermore, allergists/immunologists can play a role in building trust within these communities, partnering with other patient advocacy nonprofit stakeholders, and engaging with local, state, national, and international nongovernmental organizations, faith-based organizations, and governments. The AAAAI's Volunteerism Addressing Environmental Disparities in Allergy (VAEDIA) is the presidential task force aiming to promote volunteer initiatives by creating platforms for discussion and collaboration and by funding community-based projects to address environmental injustice.

An anthropological history of Nepal's Female Community Health Volunteer program: gender, policy, and social change.

BACKGROUND: Community health workers (CHWs) are central to Primary Health Care globally. Amidst the current flourishing of work on CHWs, there often is a lack of reference to history-even in studies of programs that have been around for decades. This study examines the 35-year trajectory of Nepal's Female Community Health Volunteers (FCHVs). METHODS: We conducted a content analysis of an archive of primary and secondary research materials, grey literature and government reports collected during 1977-2019 across several regions in Nepal. Documents were coded in MAXQDA using principles of inductive coding. As questions arose from the materials, data were triangulated with published sources. RESULTS: Looking across four decades of the program's history illuminates that issues of gender, workload, and pay-hotly debated in the CHW literature now-have been topics of discussion for observers and FCHVs alike since the inception of the program. Following experiments with predominantly male community volunteers during the 1970s, Nepal scaled up the all-female FCHV program in the late 1980s and early 1990s, in part because of programmatic goals focused on maternal and child health. FCHVs gained legitimacy as health workers in part through participation in donor-funded vertical campaigns. FCHVs received a stable yet modest regular stipend during the early years, but since it was stopped in the 1990s, incentives have been a mix of activity-based payments and in-kind support. With increasing outmigration of men from villages and growing work responsibilities for women, the opportunity cost of health volunteering increased. FCHVs started voicing their dissatisfaction with remuneration, which gave rise to labor movements starting in the 2010s. Government officials have not comprehensively responded to demands by FCHVs for decent work, instead questioning the relevance of FCHVs in a modern, medicalized Nepali health system. CONCLUSIONS: Across public health, an awareness of history is useful in understanding the present and avoiding past mistakes. These histories are often not well-archived, and risk getting lost. Lessons from the history of Nepal's FCHV program have much to offer present-day debates around CHW policies, particularly around gender, workload and payment.

A qualitative assessment of barriers and facilitators of telemedicine volunteerism during the COVID-19 pandemic in India.

BACKGROUND: The COVID-19 pandemic further propelled the recent growth of telemedicine in low-resource countries, with new models of telemedicine emerging, including volunteer-based telemedicine networks. By leveraging existing infrastructure and resources to allocate health personnel more efficiently, these volunteer networks eased some of the pandemic burden placed on health systems. However, there is insufficient understanding of volunteer-based telemedicine models, especially on the human resources engagement on such networks. This study aims to understand the motivations and barriers to health practitioner engagement on a volunteer telemedicine network during COVID-19, and the mechanisms that can potentially sustain volunteer engagement to address healthcare demands beyond the pandemic. METHODS: In-depth qualitative interviews were conducted with health practitioners volunteering on an Indian, multi-state telemedicine network during the COVID-19 pandemic. Data were analyzed using thematic content analysis methods. RESULTS: Most practitioners reported being motivated to volunteer by a sense of duty to serve during the pandemic. Practitioners suggested organizational-level measures to make the process more efficient and facilitate a more rewarding provider-patient interaction. These included screening calls, gathering patient information prior to consultations, and allowing for follow-up calls with patients to close the loop on consultations. Many practitioners stated that non-financial incentives are enough to maintain volunteer engagement. However, practitioners expressed mixed feelings about financial incentives. Some stated that financial incentives are needed to maintain long-term provider engagement, while others stated that financial incentives would devalue the volunteer experience. Most practitioners highlighted that telemedicine could increase access to healthcare, especially to the rural and underserved, even after the pandemic. Practitioners also expressed an interest in continuing to volunteer with the network if the need arose again. CONCLUSION: Our study findings suggest that practitioners are highly intrinsically motivated to volunteer during large healthcare emergencies and beyond to address the healthcare needs of the underserved. Following the recommendations presented in the study, telemedicine networks can more successfully engage and maintain volunteer practitioners. Volunteer-based telemedicine networks have the potential to bridge shortages of health personnel in resource-constrained settings both in times of crises and beyond.

Training Senior Companion Volunteers to Identify and Report Adult Abuse, Neglect, and Exploitation.

Elder abuse is a national public health challenge that can have dire consequences for the older adults who experience it in any form. The Senior Companion Program presents a unique opportunity to address this public health challenge. An in-person training for Senior Companion volunteers across Ohio on how to recognize and report elder abuse was developed, implemented, and evaluated prior to the COVID-19 pandemic. Evaluation consisted of surveys distributed prior to and at the conclusion of the training. A total of 302 volunteers were trained with a survey response rate of 76%. While there was significant knowledge improvement in one of the five knowledge items (p < .000, all other ps ≥ .065), volunteers' subjective rating of their knowledge on abuse significantly improved (p = .029). Training older adult volunteers working with other community-dwelling adults is likely a valuable strategy to educate and protect against elder abuse.

Yes, I will do it! Factors promoting the intention to volunteer after COVID-19 pandemic in Italy.

This cross-sectional study assessed the extent to which the intention to volunteer after the COVID-19 pandemic is associated with resilience, post-traumatic growth, and community service self-efficacy in a representative Italian sample (N = 295; Mage = 44.77; SD = 14.79; range = 18-83 years; 53.22% men). The model tested through a path analysis revealed a positive association between community service self-efficacy and intention to continue volunteering. Multi-group comparisons revealed that this relationship was maintained in participants who were active volunteers, while in the group of former volunteers, only a positive association between post-traumatic growth and intention to volunteer was found. This study contributed to highlight the importance of community service self-efficacy and post-traumatic growth in the volunteering experience and the intention to continue volunteering in the future.

Effects of volunteering over six months on loneliness, social and mental health outcomes among older adults: The HEAL-HOA Dual Randomized Controlled Trial.

OBJECTIVE: To determine the beneficial effects of volunteering as lay counselor via telephone on own loneliness, social network engagement, perceived social support, stress, anxiety, and depressive symptoms among Chinese older adults in Hong Kong during the COVID-19 pandemic. DESIGN, SETTING, INTERVENTION, AND PARTICIPANTS: "Helping Alleviate Loneliness in Hong Kong Older Adults" (HEAL-HOA), a dual randomized controlled trial, was implemented to test effects of telephone-based psychosocial interventions delivered by older-adult volunteers for low-income lonely older adults. To evaluate the effects of volunteering on loneliness, we randomized 375 individuals ages 50-70 into a volunteering condition versus an active control (psychoeducation with social gatherings). Following a 6-week training, participants in the volunteering condition, delivered tele-interventions to older intervention recipients. MEASUREMENT: The primary outcome was loneliness measured with the UCLA Loneliness Scale. Secondary outcomes were loneliness measured with the De Jong Gierveld Scale (DJG), social network engagement, perceived social support, perceived stress, anxiety, and depressive symptoms. Assessments were completed before training (baseline) and immediately after the 6-month volunteering period. RESULTS: Results from linear mixed models show significant positive effects of volunteering (significant interactions of condition × time) on both measures of loneliness (dppc2 = -0.41 ULCA Loneliness score, dppc2 = -0.70 total DJG score), social network engagement, stress and depressive symptoms as compared to control participants. CONCLUSIONS: The HEAL-HOA trial demonstrates beneficial effects of volunteer-delivered tele-interventions on decreasing loneliness on the volunteer interventionists themselves. Communicating these benefits for volunteers may attract more older adults into volunteering. This effective tele-based volunteer program is scalable for wider implementation. SUMMARY: This RCT tested effects of volunteering on loneliness in Hong Kong during the COVID-19-pandemic. Three hundred seventy-five individuals ages 50-70 were randomized into volunteering (delivering tele-interventions against loneliness) versus an active control condition. After 6 months, volunteers compared to controls, showed benefits on loneliness, social network engagement, stress and depressive symptoms. A program engaging lonely older adults in loneliness intervention delivery has beneficial effects on volunteers themselves and could be a scalable solution for our loneliness epidemic.

COVID-19 Pandemic, Physical Distancing Policies, and the Non-Profit Sector Volunteer Force.

Although COVID-19-related physical distancing has had large economic consequences, the impact on volunteerism is unclear. Using volunteer position postings data from Canada's largest volunteer center (Volunteer Toronto) from February 3, 2020, to January 4, 2021, we evaluated the impact of different levels of physical distancing on average views, total views, and total number of posts. There was about a 50% decrease in the total number of posts that was sustained throughout the pandemic. Although a more restrictive physical distancing policy was generally associated with fewer views, there was an initial increase in views during the first lockdown where total views were elevated for the first 4 months of the pandemic. This was driven by interest in COVID-19-related and remote work postings. This highlights the community of volunteers may be quite flexible in terms of adapting to new ways of volunteering, but substantial challenges remain for the continued operations of many non-profit organizations.

Impact on persons with disabilities and their families when they are contributors to society through volunteerism and employment.

BACKGROUND: Despite various government initiatives, people with disabilities all over the world face some degree of hindrance when they try to contribute to society. AIM: This project sought to give voice to and understand the perceptions and experiences of persons with disabilities in Singapore when contributing to society through volunteerism and employment and to explore solutions to help access and retain employment and volunteering. METHOD AND PROCEDURE: This small qualitative study recruited three convenience samples of people with disabilities aged 18-49 years old who met criteria for daily activity over the previous 12 months. Participant recruitment was limited due to the Covid pandemic lockdown. Ten individuals had maintained open employment, six had worked as a volunteer and four were neither working nor volunteering. All 20 participants were briefed online on the use of the photovoice technique. Interviews were then conducted online, beginning with a 5-min demographic survey. Approximately hour long semi-structured interviews followed. Eleven participants used photovoice but nine who were working or volunteering did not as they were unable to take photos in their workplace. Several individuals were supported during the interview by a caregiver or staff member for example a job coach. FINDINGS: Themes were identified within the four central areas of enquiry: (i) self-perceptions of being a beneficiary or contributor to society; (ii) the benefits to working and volunteering; (iii) enablers and barriers to working and volunteering and (iv) solutions to access and retain employment and volunteering. Several barriers to use of photovoice were encountered. The importance of inclusive and conducive environments was recognised along with the roles of all stakeholders across the ecosystem. CONCLUSION: Employment and volunteering can significantly impact quality of life for persons with disabilities and their families and benefit the society. Collaboration among all stakeholders is required to better address solutions and improve desired employment and volunteer outcomes.

The Effect of Home- and Community-Based Services on Social Engagement.

Objectives: Home- and community-based services (HCBS) help older adults to remain active in community settings. However, it is not known if there is a causal relationship between HCBS and social engagement. Methods: We used data from the 2010 and 2012 Health and Retirement Study and measured the effect of HCBS on social engagement via nearest-neighbor Mahalanobis matching, optimal pair matching, genetic matching, and optimal full matching. Results: Genetic matching showed that the odds of social engagement for participants who received at least one HCBS (congregate meal, home-delivered meal, transportation service, case management, homemaker or housekeeping services, or caregiver services) in the prior two years was 1.07 times more likely than participants who have not received any HCBS (robust SE = .030, p = .040). Discussion: HCBS may remove barriers to social engagement through increasing older adults' personal resources and personal networks.

Big Five personality traits predict small but robust differences in civic engagement.

OBJECTIVE: This preregistered study provides robust estimates of the links between Big Five personality traits and civic engagement across different samples and life stages. METHODS: We recruited two samples from the United States and United Kingdom (total N = 1593) and measured Big Five domains, Big Five aspects, and six civic engagement indicators: volunteerism, charitable giving, donating blood, posthumous organ donation, political voting, and vaccination. We compared the links between these measures across samples and tested moderation across life stages and several sociodemographic variables. We explored whether these links replicate between self- and peer-reports. RESULTS: We found small but robust effects. Agreeable, extraverted, and open/intellectual participants reported more civic engagement, especially volunteerism and charitable giving. Neurotic and conscientious participants mainly reported less civic engagement, especially blood and organ donations. One of the two Big Five aspects often drove these links, such as Compassion in the link between Agreeableness and volunteerism. We found some differences between younger and middle-aged adults. CONCLUSIONS: Big Five personality traits predict civic engagement modestly but consistently, with adequate study power being critical to detecting these links. Lower-order traits, such as Big Five aspects, clarify the relationships between traits and engagement. Life stages and sociodemographic variables have limited effects.

The role of civil society and the voluntary sector in children's global surgery.

An unacceptable inequity exists in the burden of pediatric surgical disease and access to surgical and anesthesia care between low- and middle-income countries (LMIC) and high-income countries (HIC). Civil society organizations (CSOs) and the voluntary sector have been integral in addressing this imbalance. This article summarizes the roles that these organizations have played in improving pediatric surgical care globally and how their roles have evolved over the years. CSOs and voluntary organizations have historically provided operations on LMIC patients; however, the focus has shifted to building sustainable surgical systems by training a skilled workforce, improving local infrastructure, and contributing to research and advocacy efforts.

Community Dermatology: Current Status and the Way Forward.

Community health interventions in dermatology have the potential to deliver healthcare to large populations. Such interventions can bridge the gap between increasing demands from vast populations and limited availability and asymmetric geographical distribution of specialist doctors. This narrative review aims to delineate various areas in which community dermatology initiatives are useful, the different approaches used, and the factors which could determine their effectiveness. We did a PubMed search using the search terms, "Community Health Services"[Mesh]) AND "Dermatology"[Mesh]. A further literature search was performed by cross-referencing these articles. In addition to its primary purpose of increasing access, community involvement can augment medical education, foster research, and help to develop more patient-centered clinical guidelines, understand disease trends and influences of the environment on various diseases, and formulate population-centered health policy. Task shifting, development of culture-sensitive and gender-sensitive community healthcare teams, disease-specific patient support groups, and use of advances in technology such as telemedicine are some of the important methods used in community dermatology. Task shifting may be performed at different levels - general practitioners, pharmacists, nurses, and community health workers. Community interventions harness volunteerism among health professionals as well as various stakeholders in the community. Partnering with non-governmental organizations, involving members of the community, and being a part of a long-term public health program help to sustain community interventions. The interventions should adapt to the ethical and cultural norms of the community. Continuity of care, fidelity, and evidence support are crucial for the success of community interventions in dermatology.