Actualising power sharing in community-led initiatives: Insights from community-based organisation leaders in Chicago, USA.

There is an increasing call for a governmental organisations such as local health departments and federal health and human service agencies to partner with community based organisations (CBOs) for health promotion. There is a large body of literature suggesting that CBOs need capacity building or empowerment to do this work, but less literature about the necessary culture shift at governmental organisations who fund public health work. This study aimed to examine the knowledge, attitudes, and beliefs of CBO leadership who do not want to partner with state funders, and understand which structures and practices demonstrate power-sharing in a community-led approach. We conducted six interviews with community-based organisation leaders and conducted a thematic analysis and a secondary, inductive discourse analysis of the transcripts to analyse why organisations chose not to apply for a government funded initiative and how they talked about power-sharing for community-led public health. Themes about the decision for CBOs to apply to the public health funding initiative: how it related to the CBO's scope of work, meeting the needs of the community, having the technical capacity, and cross-cutting themes of putting the community first and having a long-term positive impact. Organisations rejected the opportunity for this funding due to poor fit, even if they could fulfil the scope of work. A community-led approach was described as one that includes the government giving up control, creating spaces for meaningful participation and power-sharing, and systems demonstrating trust in CBOs. These findings reiterate that in order for public health to be community-led, there needs to be system-wide transformation and intentional investment that supports an infrastructure for community-led public health. State funders can learn from practices in trust-based philanthropy, such as flexible funding and reporting requirements. The results of this study can support the wider participation of CBOs in collaboration with state actors, maximising the transformative potential of collaboration, ultimately transforming power structures and advancing health equity.

Leveraging Key Informant Interviews to Inform Intervention Development: The Greater Lawndale Healthy Work Project.

BACKGROUND: The Greater Lawndale Healthy Work project is a sequential mixed methods community based participatory research project that examines work as a structural determinant of health and builds community capacity for healthy work in a predominantly Black and Latinx community in Chicago known as Greater Lawndale (GL). OBJECTIVES: We interviewed community leaders in GL as key informants to understand the barriers to healthy work and inform intervention development. METHODS: We conducted a directed content analysis of transcripts from 20 key informants and coded the social ecology and type of intervention. RESULTS: Every key informant mentioned at least one asset in GL, showing an opportunity to employ a capacity-oriented approach to intervention development. Key informants suggested a variety of interventions to address precarious work across levels of the social ecology, with individual and community level interventions being the most salient. CONCLUSION: Through this approach, we were able to navigate tensions and challenges in conducting research for community-wide change. Key informant stakeholder interviews can be leveraged to meaningfully inform intervention development and support the development of multi-level, sustainable, and culturally acceptable interventions that advance health equity.

Exploring food environment interventions for diet-related outcomes using a food sovereignty framework: a systematic review.

Building local food systems through a food sovereignty lens, harnessing the right of people to control their own food systems, may enhance healthy food access and increase the consumption of fruits and vegetables in local communities. While research to date has described the outcomes of various multilevel, multicomponent food systems interventions, no known literature reviews to date have systematically examined food system interventions and dietary and health outcomes through the context of a food sovereignty lens. Utilization of a food sovereignty framework allows for the incorporation of key food systems and community-based concepts in the food environment literature. The purpose of this systematic review was to describe and summarize the efficacy of community-based local food system interventions, using the food sovereignty framework, for both pediatric and adult populations and their impact on health behaviors and physiological outcomes. We searched for peer-reviewed articles using Scopus, PubMed, PsychInfo and CINAHL databases and identified 11 articles that met the inclusion criteria for this study. Seven studies found that food systems interventions had a significant positive effect on improving health outcomes, three had null findings and one had null or negative results. Two studies utilized a community-based participatory approach. The most successful interventions involved community-based engagement involving multiple aspects of the food system and involving both children and adults for maximum impact. Our results inform how community-based food systems interventions can be guided by food sovereignty principles to improve health outcomes, such as body weight and fruit and vegetable intake, for both pediatric and adult populations.

Patterns of Cross-Sector Collaboration in Local Health Departments: A Cluster Analysis.

Local health departments (LHDs) are positioned to act as the community health strategist for their catchment area, which requires cross-sector collaboration. However, little research exists to understand how much and what types of cross-sector collaboration occur and its impact on LHD practice. Data from 490 LHDs who participated in the 2016 National Profile of Local Health Departments survey were analyzed to identify patterns of cross-sector collaboration among LHDs. In the survey, LHDs reported the presence of collaborative activities for each of 22 categories of organizations. Factor analysis was used to identify patterns in the types of organizations with which LHDs collaborate. Then, cluster analysis was conducted to identify patterns in the types of cross-sector collaboration, and cross-sectional analyses examined which LHD characteristics were associated with cluster assignment. LHDs collaborated most with traditional health care-oriented organizations, but less often with organizations focused on upstream determinants of health such as housing. Three distinct clusters represented collaboration patterns in LHDs: coordinators, networkers, and low-collaborators. LHDs who were low-collaborators were more likely to serve smaller populations, be unaccredited, have a smaller workforce, have a White top executive, and have a top executive without a graduate degree. These findings imply that public health practitioners should prioritize building bridges to a variety of organizations and engage in collaboration beyond information sharing. Furthermore, LHDs should prioritize accreditation and workforce development activities for supporting cross-sector collaboration. With these investments, the public health system can better address the social and structural determinants of health and promote health equity.

Opioid-related risk perceptions in chronic pain: influence of patient gender and previous misuse behaviors.

ABSTRACT: Little is known about the factors that influence providers' perceptions of patient risk for aberrant opioid use. Patient gender may interact with previous opioid misuse to influence these perceptions. We asked 131 physicians to view videos and vignettes for 8 virtual patients with chronic pain. Gender (male/female) and previous prescription opioid misuse (present/absent) varied across patients; the vignettes were otherwise balanced on demographic and clinical characteristics. For each patient, providers assessed 4 risk domains: opioid-related adverse events, opioid misuse or abuse, opioid addiction, and opioid diversion. Results indicated a significant gender-by-misuse interaction for risk of opioid misuse orabuse. When previous misuse behaviors were absent, providers rated men at higher risk; there was no gender difference when previous misuse behaviors were present. A significant gender-by-misuse interaction was found for risk of opioid-related adverse events. Providers perceived men to be at higher risk when previous misuse behaviors were absent; there was no gender difference when previous misuse behaviors were present. A significant gender-by-misuse interaction was found for risk of opioid addiction. Providers rated women at higher risk when previous misuse behaviors were present and men at higher risk when previous misuse behaviors were absent. There were significant main effects of gender and misuse for risk of opioid diversion. Providers rated men and those with previous misuse behaviors at higher risk. These results demonstrate that patient gender and previous opioid misuse have unique and interactive effects on provider perceptions of prescription opioid-related risks. Studies are needed to identify the mechanisms underlying these effects, such as gender-based stereotypes about risk-taking and drug abuse.

Outcomes and Intentionality of Action Planning in Photovoice: A Literature Review.

Participatory action research methods have been utilized to engage community members in community-driven health promotion projects addressing issues across various socioecological levels. Photovoice is one such participatory action research method that allows participants to use photography to document their experiences and dialogue to eventually influence change and reach policy makers. However, it is unclear how photovoice projects demonstrate intentional action planning and its impact on community-level outcomes. The purpose of this literature review is to understand (1) how action plans are developed, initialized and implemented in the community and (2) describe community-wide changes that occurred in photovoice projects with an action planning process. We searched scholarly databases for peer-reviewed articles that used photovoice with action planning and community-level outcomes. As a result, 19 articles were included in this review. Using the socioecological model to assess the literature, we found that action planning varied at different levels of influence. The intentionality of action planning was described through the use of specific action steps, as well as intentional dissemination to stakeholders, evaluation, and sustainability primarily at the community and organization levels. Our results suggest that the most successful photovoice projects were those that were intentional in action planning. We provide recommendations for photovoice researchers to better incorporate action planning into their methodology and make use of photovoice as an action research tool that can provide a clear, sustainable path toward community-wide changes.

Work as a social determinant of health; a landscape assessment of employers in two historically disinvested urban communities.

BACKGROUND: Work is considered a structural determinant of health, yet specific determinants that could be targeted at the community level have not been elaborated. The aim of this research is to develop a methodology for incorporating employers and employment into community health assessment. METHODS: As part of a community based participatory research (CBPR) collaboration, we inventoried and characterized businesses in two neighborhoods using multiple data sources and walk-around surveys. Community and academic researchers planned, executed, discussed, and debated the methodology, the findings, and the potential for incorporating "work" in community health considerations. RESULTS: In two contiguous communities with a total population of roughly 100,000, we identified 1,127 employers: 85% were small employers; almost 70% of businesses were in retail, service, financial/business services, and food/accommodations sectors. Cash economy, hidden employment, and phantom businesses were uncovered. CONCLUSION: We developed a CBPR approach to incorporating local businesses and employment sectors into community health assessment in economically and socially disadvantaged communities. Knowing about "work" in a community will form the basis for including business owners into CBPR partnerships and incorporating work-related health and economic factors into community health improvement and quality of life plans.

Intergroup anxiety in pain care: impact on treatment recommendations made by white providers for black patients.

Race disparities in pain care are well-documented. Given that most black patients are treated by white providers, patient-provider racial discordance is one hypothesized contributor to these disparities. Research and theory suggest that providers' trait-level intergroup anxiety impacts their state-level comfort while treating patients, which, in turn, impacts their pain treatment decisions. To test these hypothesized relationships, we conducted a planned secondary analysis of data from a randomized controlled trial of a perspective-taking intervention to reduce pain treatment disparities. Mediation analyses were conducted on treatment decision data from white providers for black virtual patients with chronic pain. Results indicated that white providers with higher trait-level intergroup anxiety reported lower state-level comfort treating black patients and were thereby more likely to recommend opioid (indirect effect = 0.76, 95% confidence interval [CI]: 0.21-1.51) and pain specialty (indirect effect = 0.91, 95% CI: 0.26-1.78) treatments and less likely to recommend nonopioid analgesics (indirect effect = -0.45, 95% CI: -0.94 to -0.12). Neither trait-level intergroup anxiety nor state-level comfort significantly influenced provider decisions for physical therapy. This study provides important new information about intrapersonal and interpersonal contributors to race disparities in chronic pain care. These findings suggest that intergroup anxiety and the resulting situational discomfort encroach on the clinical decision-making process by influencing white providers' decisions about which pain treatments to recommend to black patients. Should these findings be replicated in future studies, they would support interventions to help providers become more aware of their trait-level intergroup anxiety and manage their state-level reactions to patients who are racially/ethnically different from themselves.