The KIND Challenge community intervention to reduce loneliness and social isolation, improve mental health, and neighbourhood relationships: an international randomized controlled trial.

PURPOSE: Loneliness and social isolation are risk factors for poor health, but few effective interventions are deployable at scale. This study was conducted to determine whether acts of kindness can reduce loneliness and social isolation, improve mental health, and neighbourhood social cohesion. METHOD: Three randomized controlled trials (RCTs) were conducted in the USA, UK, and Australia, involving a total of 4284 individuals aged 18-90 years old, randomized to the KIND challenge intervention or a waitlist control group. Participants allocated to the intervention were asked to do at least one act of kindness per week within a four-week period. The primary outcome was loneliness and secondary outcomes included measures of social isolation, mental health, and neighbourhood social cohesion. RESULTS: There was a significant, albeit small, intervention effect after four weeks for reduced loneliness in the USA and the UK, but not for Australia. Relative to controls, KIND challenge participants also showed significantly reduced social isolation and social anxiety in the USA, and reduced stress in Australia. There was also reduced neighbourhood conflict in the USA, increased number of neighbourhood contacts in the USA and Australia, greater neighbourhood stability and feelings of neighbourhood importance in the UK, and better neighbourhood social relationships in Australia. CONCLUSION: Promoting the provision of social support through small acts of kindness to neighbours has the potential to reduce loneliness, social isolation and social anxiety, and promote neighbourhood relationships, suggesting a potential strategy for public health campaigns. TRIAL REGISTRATION: Clinical Trials Registry. NCT04398472. Registered 21st May 2020.

Learning from community-based HIV prevention to inform control and mitigation of the COVID-19 pandemic.

The current COVID-19 pandemic and the likelihood of future viral pandemics demonstrate a need for strategic prevention campaigns that integrate biomedical, structural, and behavioral interventions within larger scale comprehensive public health initiatives. In Human Immunodeficiency Virus (HIV) prevention, community-based efforts have resulted in reductions in transmission rates, increases in testing, increases in biomedical prevention uptake, and increased engagement in secondary and tertiary prevention efforts. In this paper, we review three community-based strategies (health communication, accessible screening, and accessible prevention resources) that have demonstrated effectiveness in HIV prevention and offer recommendations for utilizing these strategies in the COVID-19 pandemic. For example, health communication strategies have positively influenced HIV testing behavior, sex communication, and condom use among HIV negative individuals and treatment initiation, treatment adherence, and retention in care among people living with HIV. In addition, studies have shown that improving accessibility of HIV screening and prevention resources in community venues such as schools, pharmacies, mobile-testing sites, churches, hair salons, and bars is useful for increasing the uptake of HIV testing, especially among disproportionately affected populations and those deemed hard to reach. Despite differences in modes of transmission, it is plausible that a synergistic multilevel response with emphasis on community-based efforts could lead to similar outcomes for the current COVID-19 pandemic and future viral pandemics. Community-based prevention strategies offer an opportunity to integrate, and bolster disconnected and siloed initiatives that achieve limited impacts independently.

Community interventions for anxiety and depression in adults and young people: A systematic review.

BACKGROUND: Growing evidence suggests that community-based interventions may be effective for anxiety and depression. This study aimed to describe studies of community interventions delivered to adults and/or young people, either in person or online, evaluated in randomised controlled trials and provide an indication as to their effectiveness, acceptability, quality of data and where possible, mechanisms of action. We included interventions delivered at and/or by museums, art galleries, libraries, gardens, music groups/choirs and sports clubs. METHOD: We developed and followed a preregistered protocol: PROSPERO CRD42020204471. Randomised controlled trials in adults and young people were identified in an extensive search with no date/time, language, document type and publication status limitations. Studies were selected according to predetermined eligibility criteria and data independently extracted and then assessed using Risk of Bias 1. The studies were deemed too heterogeneous for meta-analysis and were therefore reported using a narrative synthesis. RESULTS: Our analysis included 31 studies, with 2898 participants. Community interventions most studied in randomised controlled trials were community music (12 studies, 1432 participants), community exercise (14 studies, 955 participants) and community gardens/gardening (6 studies, 335 participants). The majority of studies were from high-income countries - many were in specific populations (such as those with physical health problems) and were generally of low quality. Dropout rates across the included studies were low (1 participant on average per 100 participants). The inadequate description of interventions limited identification of potential mechanisms of action. DISCUSSION: The uncertainty of the evidence allows only a weak recommendation in support of community interventions for anxiety and depression. The results suggest community engagement is a promising area for wide-reaching interventions to be implemented and evaluated, but more high-quality trials are needed, especially in young people and under-represented communities.

Community-Based Work and Participatory Budgeting.

Participatory budgeting (PB) works best if this activity is viewed to be part of a trend that is referred to as community-based work. But this connection is not often made. As a result, many PB projects tend to drift away from their home communities. Although working in communities is thought to be a very practical endeavor, philosophy should not be ignored, particularly if the aim is to be community-based. Some examples are supplied in this paper that illustrate how this community-based philosophy alters, and improves, some traditional phases of PB projects. The overall result is to keep these budgeting projects informed by local knowledge and under community control.

Social prescribing during the COVID-19 pandemic: a qualitative study of service providers' and clients' experiences.

BACKGROUND: COVID-19 public health restrictions, such as social distancing and self-isolation, have been particularly challenging for vulnerable people with health conditions and/or complex social needs. Link worker social prescribing is widespread in the UK and elsewhere and is regarded as having the potential to provide support to vulnerable people during the pandemic. This qualitative study explores accounts of how an existing social prescribing service adapted to meet clients' needs in the first wave of the pandemic, and of how clients experienced these changes. METHODS: Data were collected in a deprived urban area of North East England via remote interviews with clients (n = 44), link workers (n = 5) and service provider managerial staff (n = 8) from May-September 2020. Thematic data analysis was conducted. RESULTS: The research found that service providers quickly adapted to remote intervention delivery aiming to serve existing clients and other vulnerable groups. Service providers experienced improved access to some existing clients via telephone in the first months of remote delivery and in some cases were able to engage clients who had previously not attended appointments at GP surgeries. However, link workers also experienced challenges in building rapport with clients, engaging clients with the aims of the intervention and providing a service to digitally excluded people. Limited link worker capacity meant clients experienced variable contact with link workers with only some experiencing consistent support that was highly valued for helping to manage their conditions and mental wellbeing. Limited access to linked services also adversely affected clients. Clients living in less affluent circumstances and/or with worse health were more likely to experience negative impacts on their long-term condition. Some found their health and progress with social prescribing was 'on hold' or 'going backwards', which sometimes negatively affected their health. CONCLUSIONS: Social prescribing offered valued support to some during the pandemic, but remote support sometimes had limited impact for clients and findings highlight the vulnerability of social prescribing's success when linked services are disrupted. Findings also show the need for more to be done in the upscaling of social prescribing to provide support to digitally excluded populations.

Improving hypertension control and cardiovascular health: An urgent call to action for nursing.

BACKGROUND: Hypertension is a leading cause of cardiovascular disease (CVD) and affects nearly one in two adults in the United States when defined as a blood pressure of at least 130/80 mm Hg or on antihypertensive medication (Virani et al., 2021, Circulation, 143, e254). Long-standing disparities in hypertension awareness, treatment, and control among racial and ethnic populations exist in the United States. High-quality evidence exists for how to prevent and control hypertension and for the role nurses can play in this effort. In response to the 2020 Surgeon General's Call to Action to Control Hypertension, nursing leaders from 11 national organizations identified the critical roles and actions of nursing in improving hypertension control and cardiovascular health, focusing on evidence-based nursing interventions and available resources. AIMS: To develop a unified "Call to Action for Nurses" to improve control of hypertension and cardiovascular health and provide information and resources to execute this call. METHODS: This paper outlines roles that registered nurses, advanced practice nurses, schools of nursing, professional nursing organizations, quality improvement nurses, and nursing researchers can play to control hypertension and prevent CVD in the United States. It describes evidence-based interventions to improve cardiovascular health and outlines actions to bring hypertension and CVD to the forefront as a national priority for nursing. LINKING EVIDENCE TO ACTION: Evidence-based interventions exist for nurses to lead efforts to prevent and control hypertension, thus preventing much CVD. Nurses can take actions in their communities, their healthcare setting, and their organization to translate these interventions into real-world practice settings.

Budgetary allocation for health sector projects in local bodies with specific reference to noncommunicable diseases control.

Background: The role of local self-government (LSG) bodies in planning community-level interventions for noncommunicable diseases (NCD) control is critical. An understanding of how much priority is given to NCD in decentralized health planning is needed. Objective: The objective of this study is to analyze the pattern of budgetary allocation for health sector projects at different levels of LSGs in Thiruvananthapuram, Kerala, with specific reference to NCD control. Materials and Methods: Secondary data analysis was done on economic review reports and reports on health sector projects obtained from LSG department with permission. The pattern of budgetary allocation of health projects in both urban and rural local bodies of Thiruvananthapuram district for 2019-2020 was studied. Results: The proportion of NCD projects in terms of number and budget allocation, respectively, among health sector projects for gram panchayaths (GP) was 47 projects (5.25%) and 63.19 lakhs (1.8%). Figures for block panchayaths (BP) were 13 (9%) and 98.10 lakhs (10.94%), for district panchayath (DP), 1 (0.9%) and 48 lakhs (3%), for municipalities 1 (1.6%) and 4.66 lakhs (1.2%), and for corporation were 1 (1.4%) and 3 lakhs (0.16%). Only 29 (40%) GP and 5 (45%) BP had at least one NCD project. At the GP level, 21% of projects were community-based interventions and 15% of projects were for cancer screening, mental health, and hospital-based NCD clinics each. Among local bodies with lower allocation for NCD projects, the amount allocated for construction and maintenance work in health institutions was higher. Conclusion: Decision-making in decentralized health planning needs an evidence-based realignment of priorities toward NCD.

A scoping review of whole-of-community interventions on six modifiable cancer prevention risk factors in youth: A systems typology.

Whole-of-community interventions delivered across entire geospatial areas show promise for improving population health for youth cancer prevention. The aims of this scoping review were to synthesize the whole-of-community intervention literature on six modifiable risk factors in youth for cancer prevention (alcohol use, diet, obesity, physical activity, sun exposure, tobacco use) and to develop and apply a typology describing the inclusion of fundamental control system functional characteristics. A systematic search was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO, and Scopus for studies published to the end of 2019. Eligible studies included a geospatially defined whole-of-community intervention; youth 0-18 years; and at least one of the six cancer risk factor outcomes. An iterative process was undertaken to create a typology describing the functions for whole-of-community interventions guided by systems theory, and the typology was used to code the included interventions. A total of 41 interventions were included. Most interventions (43.9%) assessed multiple cancer risk factors. Few interventions provided fundamental functions necessary for community system coordination: sensor, controller, effector. Although communities are a patchwork quilt of microsystems where individuals interact in geographically bounded places nested within larger whole systems of influence, a control systems approach has not been used to frame the literature. Whole-of-community interventions can be characterized by the fundamental system functions necessary for coordinating population health improvement. Future whole-of-community intervention efforts should draw on fundamental knowledge of how systems operate and test whether adoption of the key functions is necessary for whole-of-community population health improvement.

Project ACCLAIM: Intervention Effect on Community Knowledge, Attitudes and Beliefs of Maternal and Child Health and HIV/AIDS in Eswatini, Uganda and Zimbabwe.

The ACCLAIM Study aimed to assess the effect of a package of community interventions on the demand for, uptake of, and retention of HIV-positive pregnant/postpartum women in maternal and child health (MCH) and prevention of mother-to-child HIV transmission (PMTCT) services. The study occurred from 2013 to 2015 in Eswatini, Uganda, and Zimbabwe. The three interventions were: (1) a social learning and action component for community leaders, (2) community days, and (3) peer discussion groups. Household cross-sectional surveys on community members' MCH and PMTCT knowledge, attitudes, and beliefs were analyzed pre- and post-intervention, using MCH, HIV stigma, and gender-equitable men (GEM) indicators. We used t-tests to measure the significance of mean pre- vs. post-intervention score changes stratified by gender within each intervention arm and generalized linear models to compare mean score changes of the cumulative intervention arms with the community leaders-only intervention. Response rates were over 85% for both surveys for men and women, with a total of 3337 pre-intervention and 3162 post-intervention responses. The combined package of three interventions demonstrated a significantly greater increase in MCH scores for both women (diff = 1.34, p ≤ 0.001) and men (diff = 2.03, p < 0.001). The arms that included interventions for both community leader engagement and community days (arms 2 and 3)led to a greater increase in mean GEM scores compared to the community leader engagement intervention alone (arm 1), for both women (diff = 1.32, p = 0.002) and men (diff = 1.37, p = 0.004). Our findings suggest that a package of community interventions may be most effective in increasing community MCH/HIV knowledge and improving gender-equitable norms.

Supporting maternal and child nutrition: views from community members in rural Northern Ghana.

OBJECTIVE: Despite efforts to improve maternal and child nutrition, undernutrition remains a major public health challenge in Ghana. The current study explored community perceptions of undernutrition and context-specific interventions that could improve maternal and child nutrition in rural Northern Ghana. DESIGN: This exploratory qualitative study used ten focus group discussions to gather primary data. The discussions were recorded, transcribed and coded into themes using Nvivo 12 software to aid thematic analysis. SETTING: The study was conducted in rural Kassena-Nankana Districts of Northern Ghana. STUDY PARTICIPANTS: Thirty-three men and fifty-one women aged 18-50 years were randomly selected from the community. RESULTS: Most participants reported poverty, lack of irrigated agricultural land and poor harvests as the main barriers to optimal nutrition. To improve maternal and child nutrition, study participants suggested that the construction of dams at the community level would facilitate all year round farming including rearing of animals. Participants perceived that the provision of agricultural materials such as high yield seedlings, pesticides and fertiliser would help boost agricultural productivity. They also recommended community-based nutrition education by trained health volunteers, focused on types of locally produced foods and appropriate ways to prepare them to help improve maternal and child nutrition. CONCLUSION: Drawing on these findings and existing literature, we argue that supporting community initiated nutrition interventions such as improved irrigation for dry season farming, provision of agricultural inputs and community education could improve maternal and child nutrition.

A randomised controlled trial of the Nextdoor Kind Challenge: a study protocol.

BACKGROUND: Community interventions are often promoted as a way of reducing loneliness and social isolation in our neighbourhoods. However, those community interventions are rarely examined within rigorous study designs. One strategy that holds the potential to reduce loneliness and can promote health and wellbeing is doing acts of kindness. The current study involves evaluating the impact of kindness acts on loneliness in community-dwelling individuals using an online social networking platform. METHODS: This study is made up of three randomised controlled trials conducted in three countries. Each randomised controlled trial has two arms (intervention vs waitlist control) and is designed to compare the effectiveness of the KIND challenge, which involves doing at least one act of kindness per week within a four-week period. This study will recruit users of an online community, be randomised online, and will be conducted using online assessments. We will first explore the effects of the intervention on the primary outcome of loneliness, followed by secondary outcomes, social isolation, neighbour relationship quality and contact, mental health symptoms, stress, quality of life, and positive affect. Further, we will assess the feasibility, acceptability, and safety of the KIND Challenge. DISCUSSION: This study, designed to evaluate the impact of kindness on the community, will be the first large scale randomised control trial conducted across three countries, Australia, UK, and USA. It will examine the potential of community-led interventions to reduce loneliness, improve social isolation, and promote neighbourhood cohesion, health, and wellbeing, which is especially crucial during the COVID-19 public health crisis. TRIAL REGISTRATION: Clinical Trials Registry. NCT04398472 . Registered 21st May 2020.

Community interventions for improving adult mental health: mapping local policy and practice in England.

BACKGROUND: Public mental health (PMH) aims to improve wellbeing and prevent poor mental health at the population level. It is a global challenge and a UK priority area for action. Communities play an important role in the provision of PMH interventions. However, the evidence base concerning community-based PMH interventions is limited, meaning it is challenging to compare service provision to need. Without this, the efficient and equitable provision of services is hindered. Here, we sought to map the current range of community-based interventions for improving mental health and wellbeing currently provided in England to inform priority areas for policy and service intervention. METHOD: We adopted an established mapping exercise methodology, comparing service provision with demographic and deprivation statistics. Five local authority areas of England were selected based on differing demographics, mental health needs and wider challenging circumstances (i.e. high deprivation). Community-based interventions were identified through: 1) desk-based research 2) established professional networks 3) chain-referral sampling of individuals involved in local mental health promotion and prevention and 4) peer researchers' insight. We included all community-based, non-clinical interventions aimed at adult residents operating between July 2019 and May 2020. RESULTS: 407 interventions were identified across the five areas addressing 16 risk/protective factors for PMH. Interventions for social isolation and loneliness were most prevalent, most commonly through social activities and/or befriending services. The most common subpopulations targeted were older adults and people from minority ethnic backgrounds. Interventions focusing on broader structural and environmental determinants were uncommon. There was some evidence of service provision being tailored to local need, though this was inconsistent, meaning some at-risk groups such as men or LGBTQ+ people from minority ethnic backgrounds were missed. Interventions were not consistently evaluated. CONCLUSIONS: There was evidence of partial responsiveness to national and local prioritising. Provision was geared mainly towards addressing social and individual determinants of PMH, suggesting more integration is needed to engage wider service providers and policy-makers in PMH strategy and delivery at the community level. The lack of comprehensive evaluation of services to improve PMH needs to be urgently addressed to determine the extent of their effectiveness in communities they serve.

Evaluation of a campaign to reduce consumption of sugar-sweetened beverages in New Jersey.

Obesity is a leading cause of premature death in the U.S., in part due to consumption of sugar sweetened beverages (SSBs). In New Jersey, African Americans, Hispanics, and those of low income have the highest rates of SSB consumption. This study evaluates the impact of NJ Sugarfreed, a campaign designed to reduce sugar-sweetened beverage (SSB) consumption across New Jersey. From 12/1/17-9/30/18, we used a collective impact model to create targeted statewide campaigns that reduce SSB consumption among New Jersey residents, with an emphasis on African American and Hispanic low-income mothers/caregivers who are often gatekeepers to children's SSB consumption. Passaic County, New Jersey received a higher dose intervention. Messages were disseminated through social media, partner organizations, and community partnerships. Campaign impact was examined through evaluation surveys and analysis of beverage sales. Baseline and follow-up surveys (n = 800 baseline; n = 782 follow-up) showed positive trends toward decreased soda consumption and increased knowledge about SSBs. Passaic respondents showed a 5% decrease in those who consume 1+ soda per day, compared to a 1% decrease among New Jersey respondents. Analysis of overall SSB beverage sales showed the most pronounced decreases in Passaic (7% decrease) compared to New Jersey (6%). By drawing upon best practices in message development and the use of various platforms for dissemination, combined with community-based participation, we have provided more evidence to support the use of a collective impact model as a way of reducing unhealthy behaviors that impact health disparities.

Maternal and newborn care during the COVID-19 pandemic in Kenya: re-contextualising the community midwifery model.

Peripartum deaths remain significantly high in low- and middle-income countries, including Kenya. The COVID-19 pandemic has disrupted essential services, which could lead to an increase in maternal and neonatal mortality and morbidity. Furthermore, the lockdowns, curfews, and increased risk for contracting COVID-19 may affect how women access health facilities. SARS-CoV-2 is a novel coronavirus that requires a community-centred response, not just hospital-based interventions. In this prolonged health crisis, pregnant women deserve a safe and humanised birth that prioritises the physical and emotional safety of the mother and the baby. There is an urgent need for innovative strategies to prevent the deterioration of maternal and child outcomes in an already strained health system. We propose strengthening community-based midwifery to avoid unnecessary movements, decrease the burden on hospitals, and minimise the risk of COVID-19 infection among women and their newborns.

A qualitative study of social connectedness and its relationship to community health programs in rural Chiapas, Mexico.

BACKGROUND: Social connectedness is an important predictor of health outcomes and plays a large role in the physical and mental health of an individual and a community. The presence of a functioning health clinic with a community health worker program may indirectly improve health outcomes by increasing the social connectedness of the community in addition to providing direct patient care. This study examines the social connectedness of the inhabitants of three Mexican towns within the catchment area of a healthcare Non-Government Organization (NGO) through a qualitative analysis. METHODS: Willing participants were videotaped answering open-ended questions about their community and use of healthcare resources. Interviews were then coded for relevant themes and analyzed for content relating to social connectedness, social isolation, and health. RESULTS: Respondents reported that having a functioning community clinic had improved their lives significantly through direct provision of care and by reducing the financial burden of travel to seek medical care elsewhere. Respondents from each town differed slightly in their primary means of social support. One town relied more heavily on organized groups (i.e., religious groups) for their support system. Social isolation was reported most frequently by housewives who felt isolated in the home and by respondents that had to deal with personal illness. Respondents that self-identified as Community Health Workers (CHWs) in their respective communities acknowledged that their roles bestowed physical and psychological health benefits upon themselves and their families. CONCLUSIONS: Overall, a long-term health intervention may directly impact the relative social isolation and social connectedness of a community's inhabitants. The social connectedness of the community is an important quality that must be considered when evaluating and planning health interventions.

Alcohol use in fishing communities and men's willingness to participate in an alcohol, violence and HIV risk reduction intervention: qualitative findings from Rakai, Uganda.

Alcohol use, intimate partner violence (IPV) and HIV infection are associated, but few programmes and interventions have addressed their synergistic relationship or been evaluated for effectiveness and acceptability. This is a critical gap in populations with high rates of alcohol use, HIV and IPV, such as Uganda's fishing communities. This study examined drinking norms, barriers and facilitators to engagement in a risk reduction programme, and ideas for tailoring. Results showed that alcohol use is common in fishing villages. While men and women drink, gendered notions of femininity deem alcohol largely unacceptable for women. Plastic sachets of liquor were the most common alcoholic drink. Participants did not understand the definition of 'hazardous drinking', but recognised connections between drinking, violence and sexual risk-taking. The idea of an alcohol, IPV and HIV risk reduction intervention was supported, but barriers need to be addressed, including how best to help those uninterested in reducing their drinking, addressing normalisation of drinking and how best to inform those who truly need intervention. Intervention to people living with HIV around the time of diagnosis and treatment may be warranted. Study findings highlight the potential to integrate alcohol and IPV reduction programmes into an HIV service provision.

Recreation centre managers' perceptions of pricing interventions to promote healthy eating.

Retailers have the capacity to improve the food and beverage environment by making healthier options more affordable and attractive for their consumers. The perspectives of retailers on feasible and acceptable pricing strategies are not known. The aim of this study was to understand retailers' perceptions of factors that are relevant to feasible and acceptable health-promoting food and beverage pricing interventions. A convenience sample of 11 aquatic and recreation centre managers in Victoria, Australia was recruited to participate in semi-structured interviews. We took a pragmatic approach with the aim of understanding retailers' perceptions of factors that affect the feasibility and acceptability of pricing interventions within their facilities. Thematic analysis was used to synthesize and interpret retailers' perceptions of pricing interventions. Key themes identified were: structural and organizational characteristics (the internal and external characteristics of aquatic and recreation centres), characteristics of feasible pricing changes (type, magnitude and products targeted by pricing strategies) and business outcomes (profits and customer feedback). Results suggest that pricing interventions to promote healthy food and beverage choices can be feasible and acceptable to retailers, though contextual considerations are likely to be important. Future studies should use these findings to design interventions most likely to be acceptable to retailers, work with retailers to implement health-promoting food and beverage pricing interventions, evaluate the impact on business outcomes including customer perspectives and profitability, and test transferability to other retail settings.

Diabetes Prevention Programs in Rural North America: a Systematic Scoping Review.

AIMS: The aims of this systematic scoping review were to characterize the extent to which diabetes prevention programs have focused on rural populations in North America and where possible, identify efficacious program components. METHODS: The review was guided by the PRISMA statement and five steps for scoping studies. Searches were conducted in August 2017 in Tucson, Arizona. Two teams of three independently screened full texts, excluding prior reviews, systematic reviews, and opinion pieces. Two authors abstracted data, which were reviewed by other team members. RESULTS: Of the 12,840 articles identified, 12 met all criteria. Nine studies were based in the USA and three were Canadian. Demographics reflected high enrollment of underrepresented minorities, adults, and females. Methodological rigor was low; most studies were single-arm interventions evaluated using pre-/post-measures. Weight was measured across all studies, although biological, behavioral, and psychosocial outcomes were inconsistently assessed. Eight studies reported significant changes in primary outcomes. Duration and intensity were variable; delivery was led by trained volunteers or health professionals. Seven studies reported recruitment, retention, and adherence data. CONCLUSIONS: Surprisingly, few rural diabetes prevention studies have been published. Published programs were notable for lack of youth and/or family involvement, integrated prevention and treatment programs, and heavy reliance on self-reported outcomes.

Community Interventions to Promote Mental Health and Social Equity.

PURPOSE OF REVIEW: We review recent community interventions to promote mental health and social equity. We define community interventions as those that involve multi-sector partnerships, emphasize community members as integral to the intervention, and/or deliver services in community settings. We examine literature in seven topic areas: collaborative care, early psychosis, school-based interventions, homelessness, criminal justice, global mental health, and mental health promotion/prevention. We adapt the social-ecological model for health promotion and provide a framework for understanding the actions of community interventions. RECENT FINDINGS: There are recent examples of effective interventions in each topic area. The majority of interventions focus on individual, family/interpersonal, and program/institutional social-ecological levels, with few intervening on whole communities or involving multiple non-healthcare sectors. Findings from many studies reinforce the interplay among mental health, interpersonal relationships, and social determinants of health. There is evidence for the effectiveness of community interventions for improving mental health and some social outcomes across social-ecological levels. Studies indicate the importance of ongoing resources and training to maintain long-term outcomes, explicit attention to ethics and processes to foster equitable partnerships, and policy reform to support sustainable healthcare-community collaborations.

A Community-Based Intervention for the Detection of Chagas Disease in Barcelona, Spain.

Chagas disease (CHD) has become a challenge in Spain due to the high prevalence of immigrants coming from endemic areas. One of the main difficulties for its control and elimination is its underdiagnosis. The identification and integral treatment of CHD are key to increasing rates of diagnosis, overcoming psycho-social barriers and avoiding CHD progression. Community interventions with in situ screening have proven to be a useful tool in detecting CHD among those with difficulties accessing health services. To determine the underdiagnosis rate of the population most susceptible to CHD among those attending two different Bolivian cultural events celebrated in Barcelona; to describe the sociodemographic characteristics of the people screened; and to analyse the results of the screening. The community interventions were carried out at two Bolivian cultural events held in Barcelona in 2017. Participants were recruited through community health agents. A questionnaire was given to determine the participants' prior knowledge of CHD. In situ screening was offered to those who had not previously been screened. Those who did not wish to be screened were asked for the reason behind their decision. Results were gathered in a database and statistical analyses were performed using STATA v14. 635 interviews were carried out. 95% of the subjects reported prior knowledge of CHD. 271 subjects were screened: 71.2% women and 28.8% men, of whom 87.8% were of Bolivian origin. The prevalence of CHD was 8.9%. Community health interventions with in situ screening are essential to facilitating access to diagnosis.