A Scoping Review of Bikeability Assessment Methods.

Bicycling holds promise as a healthy and sustainable means of transportation and physical activity. Despite the growing interest in community-based environmental approaches to promoting physical activity, bikeability has received relatively little attention. This paper provides a scoping review of the instruments developed to measure bikeability along with practice-based analyses of the tools related to user expertise, estimated cost, and required time to implement. The review summarizes the literature, identifies research gaps, and informs stakeholders with articles from EBSCO and transportation databases published after 2003 when the previous bikeability instrument review paper was published. Data extraction included the tool name, data collection method, study location, data collection scale, type of measure, and description. Two reviewers independently reviewed articles included in the full text review, and the inter-rater agreement exceeded 90%. The database search yielded 388 unique articles, and 17 met the inclusion/exclusion criteria. Most of the studies, 11 of 17, were applied to settings outside of the U.S. Five studies employed a self-report survey, and five studies examined bikeability using geospatial data, like GIS. Seven studies used a direct observation audit tool-one specifically using a mobile app and another using virtual observation techniques with Google Street View. Bikeability tools are useful for assessing communities and their supports for bicycling. Our primary finding is that advances in technology over the past two decades have driven innovative and useful methodologies, in a variety of disciplines, for assessing the environment, but more consensus is needed to provide a universal definition of bikeability.

Determinants of undisclosed HIV status to a community-based HIV program: findings from caregivers of orphans and vulnerable children in Tanzania.

BACKGROUND: HIV status disclosure facilitates receipt of HIV prevention and treatment services. Although disclosure to sexual partners, family members or friends has been extensively studied, disclosure to community-based HIV programs is missing. This study assesses the magnitude of, and factors associated with undisclosed HIV status to a community-based HIV prevention program among caregivers of orphans and vulnerable children (OVC) in Tanzania. METHODS: Data are from the USAID-funded Kizazi Kipya project that seeks to increase uptake of HIV, health, and social services by OVC and their caregivers in Tanzania. Data on OVC caregivers who were enrolled in the project during January-March 2017 in 18 regions of Tanzania were analyzed. Caregivers included were those who had complete information on their HIV status disclosure, household socioeconomic status, and sociodemographic characteristics. HIV status was self-reported, with undisclosed status representing all those who knew their HIV status but did not disclose it. Multilevel mixed-effects logistic regression, with caregivers' HIV status disclosure being the outcome variable was conducted. RESULTS: The analysis was based on 59,683 OVC caregivers (mean age = 50.4 years), 71.2% of whom were female. Of these, 37.2% did not disclose their HIV status to the USAID Kizazi Kipya program at the time of enrollment. Multivariate analysis showed that the likelihood of HIV status non-disclosure was significantly higher among: male caregivers (odds ratio (OR) = 1.22, 95% confidence interval (CI) 1.16-1.28); unmarried (OR = 1.12, 95% CI 1.03-1.23); widowed (OR = 1.12, 95% CI 1.07-1.18); those without health insurance (OR = 1.36, 95% CI 1.28-1.45); age 61 + years (OR = 1.72, 95% CI 1.59-1.88); those with physical or mental disability (OR = 1.14, 95% CI 1.04-1.25); and rural residents (OR = 1.58, 95% CI 1.34-1.86). HIV status non-disclosure was less likely with higher education (p < 0.001); and with better economic status (p < 0.001). CONCLUSION: While improved education, economic strengthening support and expanding health insurance coverage appear to improve HIV status disclosure, greater attention may be required for men, unmarried, widowed, rural residents, and the elderly populations for their higher likelihood to conceal HIV status. This is a clear missed opportunity for timely care and treatment services for those that may be HIV positive. Further support is needed to support disclosure in this population.

Understanding the Collaborative Planning Process in Homeless Services: Networking, Advocacy, and Local Government Support May Reduce Service Gaps.

OBJECTIVE: The Continuum of Care (CoC) process-a nationwide system of regional collaborative planning networks addressing homelessness-is the chief administrative method utilized by the US Department of Housing and Urban Development to prevent and reduce homelessness in the United States. The objective of this study is to provide a benchmark comprehensive picture of the structure and practices of CoC networks, as well as information about which of those factors are associated with lower service gaps, a key goal of the initiative. DESIGN: A national survey of the complete population of CoCs in the United States was conducted in 2014 (n = 312, 75% response rate). This survey is the first to gather information on all available CoC networks. Ordinary least squares (OLS) regression was used to determine the relationship between internal networking, advocacy frequency, government investment, and degree of service gaps for CoCs of different sizes. SETTING: United States. PARTICIPANTS: Lead contacts for CoCs (n = 312) that responded to the 2014 survey. MAIN OUTCOME MEASURE: Severity of regional service gaps for people who are homeless. RESULTS: Descriptive statistics show that CoCs vary considerably in regard to size, leadership, membership, and other organizational characteristics. Several independent variables were associated with reduced regional service gaps: networking for small CoCs (ß = -.39, P < .05) and local government support for midsized CoCs (ß = -.10, P < .05). For large CoCs, local government support was again significantly associated with lower service gaps, but there was also a significant interaction effect between advocacy and networking (ß = .04, P < .05). CONCLUSIONS: To reduce service gaps and better serve the homeless, CoCs should consider taking steps to improve networking, particularly when advocacy is out of reach, and cultivate local government investment and support.

Accredited Health Department Partnerships to Improve Health: An Analysis of Community Health Assessments and Improvement Plans.

CONTEXT: The Public Health Accreditation Board (PHAB) Standards & Measures require the development and updating of collaborative community health assessments (CHAs) and community health improvement plans (CHIPs). OBJECTIVE: The goal of this study was to analyze the CHAs and CHIPs of PHAB-accredited health departments to identify the types of partners engaged, as well as the objectives selected to measure progress toward improving community health. DESIGN: The study team extracted and coded data from documents from 158 CHA/CHIP processes submitted as part of the accreditation process. Extracted data included population size, health department type, data sources, and types of partner organizations. Health outcome objectives were categorized by Healthy People 2020 Leading Health Indicator (LHI), as well as by the 7 broad areas in the PHAB reaccreditation framework for population health outcomes reporting. PARTICIPANTS: Participants included health departments accredited between 2013 and 2016 that submitted CHAs and CHIPs to PHAB, including 138 CHAs/CHIPs from local health departments and 20 from state health departments. RESULTS: All the CHAs/CHIPs documented collaboration with a broad array of partners, with hospitals and health care cited most frequently (99.0%). Other common partners included nonprofit service organizations, education, business, and faith-based organizations. Small health departments more frequently listed many partner types, including law enforcement and education, compared with large health departments. The majority of documents (88.6%) explicitly reference Healthy People 2020 goals, with most addressing the LHIs nutrition/obesity/physical activity and access to health services. The most common broad areas from PHAB's reaccreditation framework were preventive health care and individual behavior. CONCLUSIONS: This study demonstrates the range of partners accredited health departments engage with to collaborate on improving their communities' health as well as the objectives used to measure community health improvement. This illustrates the collaborative nature in which accredited health departments tackle community priorities.

Pediatric Oncology Clinic Care Model: Achieving Better Continuity of Care for Patients in a Medium-sized Program.

Providing the best care in both the inpatient and outpatient settings to pediatric oncology patients is all programs goal. Using continuous improvement methodologies, we changed from a solely team-based physician care model to a hybrid model. All patients were assigned a dedicated oncologist. There would then be 2 types of weeks of outpatient clinical service. A "Doc of the Day" week where each oncologist would have a specific day in clinic when their assigned patients would be scheduled, and then a "Doc of the Week" week where one physician would cover clinic for the week. Patient satisfaction surveys done before and 14 months after changing the model of care showed that patients were very satisfied with the care they received in both models. A questionnaire to staff 14 months after changing showed that the biggest effect was increased continuity of care, followed by more efficient clinic workflow and increased consistency of care. Staff felt it provided better planning and delivery of care. A hybrid model of care with a primary physician for each patient and assigned clinic days, alternating with weeks of single physician coverage is a feasible model of care for a medium-sized pediatric oncology program.

Making the Most of Our Community Health Assessment by Developing a Framework for Evaluation.

The Health District of Northern Larimer County is a special district delivering community health programs and services in Northern Colorado. Since 1995, we have conducted a community health assessment (CHA) every 3 years. In 2015, we looked at our CHA process to see whether improvements could be made. We gathered information to understand recommended processes and potential impacts of CHA. We then developed a logic model to describe our CHA process and intended outcomes. The model outlined our CHA activities and impacts and informed our evaluation questions. We identified areas for process improvement, including our ability to analyze health inequities and effectively disseminate CHA data and findings. We recommend that others conducting a CHA evaluate their processes and impacts. Developing a logic model can be a first step toward creating an evaluation. While evaluation requires resources, we believe that the practice of CHA could greatly benefit from additional evaluation efforts.

Effectiveness of Health Impact Assessments: A Synthesis of Data From Five Impact Evaluation Reports.

INTRODUCTION: Since the 1990s, the use of health impact assessments (HIAs) has grown for considering the potential health impacts of proposed policies, plans, programs, and projects in various sectors. Evaluation of HIA impacts is needed for understanding the value of HIAs, improving the methods involved in HIAs, and potentially expanding their application. Impact evaluations examine whether HIAs affect decisions and lead to other effects. METHODS: I reviewed HIA impact evaluations identified by literature review and professional networking. I abstracted and synthesized data on key findings, success factors, and challenges from 5 large evaluations conducted in the United States, Europe, Australia, and New Zealand and published from 2006 through 2015. These studies analyzed impacts of approximately 200 individual HIAs. RESULTS: Major impacts of HIAs were directly influencing some decisions, improving collaboration among stakeholders, increasing awareness of health issues among decision makers, and giving community members a stronger voice in local decisions. Factors that contributed to successful HIAs included engaging stakeholders, timeliness, policy and systems support for conducting HIAs, having people with appropriate skills on the HIA team, obtaining the support of decision makers, and providing clearly articulated, feasible recommendations. Challenges that may have reduced HIA success were poor timeliness, underestimation of time and resources needed, difficulty in accessing relevant data, use of jargon in HIA reports, difficulty in involving decision makers in the HIA process, and absence of a requirement to conduct HIAs. CONCLUSION: HIAs can be useful to promote health and mitigate adverse impacts of decisions made outside of the health sector. Stakeholder interactions and community engagement may be as important as direct impacts of HIAs. Multiple factors are required for HIA success. Further work could strengthen the role of HIAs in promoting equity, examine HIA impacts in specific sectors, and document the role of HIAs in a "health in all policies" approach.

A Community Health Record: Improving Health Through Multisector Collaboration, Information Sharing, and Technology.

We present a framework for developing a community health record to bring stakeholders, information, and technology together to collectively improve the health of a community. It is both social and technical in nature and presents an iterative and participatory process for achieving multisector collaboration and information sharing. It proposes a methodology and infrastructure for bringing multisector stakeholders and their information together to inform, target, monitor, and evaluate community health initiatives. The community health record is defined as both the proposed framework and a tool or system for integrating and transforming multisector data into actionable information. It is informed by the electronic health record, personal health record, and County Health Ranking systems but differs in its social complexity, communal ownership, and provision of information to multisector partners at scales ranging from address to zip code.

Interdisciplinary Shared Governance in Ambulatory Care: One Health System's Journey.

The implementation of shared governance structures in acute care has illustrated the positive relationship between shared decision making and nurse empowerment and positive nurse and patient outcomes. Little is known, however, about interdisciplinary shared governance, and even less is known about shared governance in ambulatory care. This article details one health system's experience with the implementation of an interdisciplinary shared governance structure in ambulatory care over a 4-year period. The authors report lessons learned, positive health system outcomes that resulted including improved communication, better preparedness for accreditation visits, improved assessment of fall risk, and a streamlined documentation system. Also discussed are mechanisms to enhance sustainability of the structure and discussion of future opportunities and challenges.

From knowing our needs to enacting change: findings from community consultations with indigenous communities in Bangladesh.

INTRODUCTION: Indigenous peoples are among the most marginalized peoples in the world due to issues relating to well-being, political representation, and economic production. The research consortium Goals and Governance for Global Health (Go4Health) conducted a community consultation process among marginalized groups across the global South aimed at including their voices in the global discourse around health in the post-2015 development agenda. This paper presents findings from the consultations carried out among indigenous communities in Bangladesh. METHODS: For this qualitative study, our research team consulted the Tripura and Mro communities in Bandarban district living in the isolated Chittagong Hill Tracts region. Community members, leaders, and key informants working in health service delivery were interviewed. Data was analyzed using thematic analysis. FINDINGS: Our findings show that remoteness shapes the daily lives of the communities, and their lack of access to natural resources and basic services prevents them from following health promotion messages. The communities feel that their needs are impossible to secure in a politically indifferent and sometimes hostile environment. CONCLUSION: Communities are keen to participate and work with duty bearers in creating the conditions that will lead to their improved quality of life. Clear policies that recognize the status of indigenous peoples are necessary in the Bangladeshi context to allow for the development of services and infrastructure.

A population-based analysis of use and outcomes of laparoscopic bariatric surgery across socioeconomic groups in Taiwan.

BACKGROUND: With the growing development of minimally invasive techniques for the treatment of morbid obesity, laparoscopic bariatric surgery (LBS) is increasingly performed. This study aimed to assess the association between patients' socioeconomic status (SES) and the likelihood of undergoing LBS and related outcomes in Taiwan. METHODS: This nationwide population-based study was conducted by using data from Taiwan's National Health Insurance Research Database. A total of 3678 morbidly obese patients aged 18 years and older who underwent conventional open bariatric surgery or LBS were identified between 2004 and 2011. Regression analyses were performed using generalized estimating equation (GEE) models to account for the nesting of patients within physician to assess patients' SES category associated with the use of LBS and related outcomes. Odds ratios (ORs) and 95 % confidence intervals (CIs) were estimated. RESULTS: Compared with those with medium and low SES (84.6 % and 80.2 %), patients with high SES (88.1 %) had the highest percentage of undergoing LBS (P < 0.001). After adjusting for patient demographics, institution and surgeon characteristics, the multivariate GEE analysis revealed that the highest likelihood of undergoing LBS was noted in morbidly obese patients with high SES (OR = 1.45, 95 % CI 1.10-1.90), followed by those with medium SES (OR = 1.27, 95 % CI 1.04-1.56). In addition, patients with high SES had slightly lower length of hospital stay (LOS; OR = 0.90, 95 % CI 0.82-0.99) and hospital treatment cost (OR = 0.93, 95 % CI 0.87-0.99) than their counterparts after adjustment. CONCLUSIONS: The increased likelihood of undergoing LBS and lower LOS and hospital treatment cost were noted among morbidly obese patients with higher SES. This finding suggests there is the need to improve clinical practice and reduce health disparities in the surgical treatment of morbidly obese patients.

Professional role identity in shaping community nurses' reactions to nursing policy.

AIM: To establish the extent to which professional role identity shapes community nurses' reactions before the implementation of a policy that sought to introduce a generic role. BACKGROUND: Many countries seek to alter community nurse roles to address changes in population health and health workforce. We know little about the influences that might shape nurses' reaction to these policies before their implementation and our theoretical understanding is poorly developed at this point in the policy-making cycle. METHOD: Self completed cross-sectional survey of 703 community nurses before the introduction of a generic Community Health Nurse role in Scotland. RESULT: The minority (33%) supported the new role. The professional role identity of those who were supportive differed significantly from those who did not support the policy or were uncertain of it. CONCLUSION: It is possible that the new policy acted to increase the value of the professional role identity of those who were supportive and conversely devalued the professional role identity of those who were unsupportive or uncertain of it. IMPLICATIONS: Professional role identity should be considered by policy makers in any country seeking to introduce policies that aim to radically change the role of community nurses and that this is acknowledged at an early stage in the policy-making cycle.

Use of the community assessment for public health emergency response to conduct community health assessments for public health accreditation.

A community health assessment (CHA) is a collaborative process of collecting and analyzing data to learn about the health status of a community. Community health assessments are also a requirement of public health accreditation for state and local health departments and of the Affordable Care Act for nonprofit hospitals. One element of a CHA is primary data collection. This article describes the use of the Community Assessment for Public Health Emergency Response (CASPER) method for primary data collection to meet public health accreditation requirements in 2 case study communities--Nashua, New Hampshire, and Davidson County, North Carolina; CASPER is a flexible and efficient method for the collection of population-based primary data in an urban or rural setting.

Voices across Kansas: community health assessment and improvement efforts among local health departments.

CONTEXT: Community health assessment (CHA) and community health improvement planning (CHIP) is central to public health accreditation and essential functions and therefore important to local health departments (LHDs). However, rural states face significant challenges to pursue public health accreditation. OBJECTIVE: The purpose of this statewide study was to identify factors that impede or promote the timeliness of CHA and CHIP completion. DESIGN: Fifteen focus groups, representing 11 of 15 public health regions, were conducted via telephone, using a structured interview script between April and September 2012. SETTING: The sampling frame for the project was represented by counties in Kansas that planned to conduct a CHA-CHIP activity during 2012. PARTICIPANTS: Participants (N = 76) were LHD administrators, hospital representatives, and key community stakeholders from frontier, rural, and urban settings who were involved in CHA-CHIP activities. They were predominantly female (86.0%) and 51 years or older (66.7%). MAIN OUTCOME MEASURES: The study assessed perceptions and opinions about the inputs, process, outputs, and outcomes of CHA-CHIP activities within the community. RESULTS: Overall, CHA-CHIP implementation in Kansas was in its early stages. Rural counties reported a lack of capacity and confidence to perform many CHA-CHIP activities. Early CHA-CHIP adopters were located in more populous, metropolitan areas and had progressed further into the CHA-CHIP process. Regardless of rural/urban status, a history of collaborative activity among community stakeholder groups appeared to promote progress in CHA-CHIP completion. Participants reported that additional funding, time, trained staff, technical assistance, and community leadership were needed to conduct CHA-CHIP activities. Barriers included maintaining required LHD services while conducting assessment and planning activities and differences in public health and federal cycles for performing CHA. CONCLUSIONS: Study findings have implications for strengthening rural workforce development and technical assistance for CHA-CHIP activities.

Improving public health through state health improvement planning: a framework for action.

BACKGROUND: State health improvement plans (SHIPs) identify priorities for making the greatest impacts on health promotion and disease prevention, specific to the needs of state populations. Both SHIPs and the state health assessments on which they are based are prerequisites for Public Health Accreditation Board national accreditation. OBJECTIVE: To identify and evaluate existing SHIPs to develop guidance to support health departments in the state health improvement planning process. DESIGN: In 2010, the Association of State and Territorial Health Officials (ASTHO) conducted a comprehensive search for existing SHIPs. A systematic evaluation of existing SHIPS was accomplished by means of primary source document review using a standardized data collection form. Using data derived from these SHIPs and guidance from a workgroup of practitioners, ASTHO developed the ASTHO SHIP Guidance and Resources (SHIP Guidance) Framework. RESULTS: The search yielded 25 states (49%) having a SHIP completed or in progress. Fifteen states (29%) had no SHIP but had a Healthy People plan, and 10 states (20%) had no SHIP or Healthy People plan. No information was available for 1 state. Findings were reviewed, evaluated, and incorporated into the SHIP Guidance. The SHIP Guidance provides a framework for the implementation, monitoring, and evaluation of a SHIP process using 12 key steps. CONCLUSIONS: As public health/health care integration and accreditation readiness activity grows, multisector engagement through a SHIP will continue to be a priority for state public health and improving health outcomes. The SHIP Guidance provides a systematic, flexible approach for states conducting or updating state health assessments and SHIPs.

CDC/NACCHO Accreditation Support Initiative: advancing readiness for local and tribal health department accreditation.

CONTEXT: Health departments have various unique needs that must be addressed in preparing for national accreditation. These needs require time and resources, shortages that many health departments face. OBJECTIVE: The Accreditation Support Initiative's goal was to test the assumption that even small amounts of dedicated funding can help health departments make important progress in their readiness to apply for and achieve accreditation. DESIGN: Participating sites' scopes of work were unique to the needs of each site and based on the proposed activities outlined in their applications. Deliverables and various sources of data were collected from sites throughout the project period (December 2011-May 2012). SETTING/PARTICIPANTS: Awardees included 1 tribal and 12 local health departments, as well as 5 organizations supporting the readiness of local and tribal health departments. RESULTS: Sites dedicated their funding toward staff time, accreditation fees, completion of documentation, and other accreditation readiness needs and produced a number of deliverables and example documents. All sites indicated that they made accreditation readiness gains that would not have occurred without this funding. CONCLUSIONS: Preliminary evaluation data from the first year of the Accreditation Support Initiative indicate that flexible funding arrangements may be an effective way to increase health departments' accreditation readiness.

Harnessing the power of the grassroots to conduct public health research in sub-Saharan Africa: a case study from western Kenya in the adaptation of community-based participatory research (CBPR) approaches.

BACKGROUND: Community-based participatory research (CBPR) is a collaborative approach to research that involves the equitable participation of those affected by an issue. As the field of global public health grows, the potential of CBPR to build capacity and to engage communities in identification of problems and development and implementation of solutions in sub-Saharan Africa has yet to be fully tapped. The Orphaned and Separated Children's Assessments Related to their Health and Well-Being (OSCAR) project is a longitudinal cohort of orphaned and non-orphaned children in Kenya. This paper will describe how CBPR approaches and principles can be incorporated and adapted into the study design and methods of a longitudinal epidemiological study in sub-Saharan Africa using this project as an example. METHODS: The CBPR framework we used involves problem identification, feasibility and planning; implementation; and evaluation and dissemination. This case study will describe how we have engaged the community and adapted CBPR methods to OSCAR's Health and Well-being Project's corresponding to this framework in four phases: 1) community engagement, 2) sampling and recruitment, 3) retention, validation, and follow-up, and 4) analysis, interpretation and dissemination. RESULTS: To date the study has enrolled 3130 orphaned and separated children, including children living in institutional environments, those living in extended family or other households in the community, and street-involved children and youth. Community engagement and participation was integral in refining the study design and identifying research questions that were impacting the community. Through the participation of village Chiefs and elders we were able to successfully identify eligible households and randomize the selection of participants. The on-going contribution of the community in the research process has been vital to participant retention and data validation while ensuring cultural and community relevance and equity in the research agenda. CONCLUSION: CBPR methods have the ability to enable and strengthen epidemiological and public health research in sub-Saharan Africa within the social, political, economic and cultural contexts of the diverse communities on the continent. This project demonstrates that adaptation of these methods is crucial to the successful implementation of a community-based project involving a highly vulnerable population.

The return of the city-state: urban governance and the New York City H1N1 pandemic.

This article examines New York City's response to the 2009 H1N1 pandemic in the context of the post-9/11 US security regime. While the federal level 'all-hazards' approach made for greater depth of support, it also generated unrealistic assumptions at odds with an effective local response. The combination of structurally induced opportunity and actor specific strengths (size, expertise) made for effective local governance by the New York City Department of Health and Mental Hygiene. By underlining the importance of locality as a first line of defence and linking defence function to policy initiative in regard to health governance, this study illustrates the continuing relevance of Weber's insight into the institutional structure of the city.

Active living collaboratives in the United States: understanding characteristics, activities, and achievement of environmental and policy change.

INTRODUCTION: Changing the built environment to promote active lifestyles requires collaboration among diverse sectors. Multisectoral collaborative groups in the United States promote active lifestyles through environmental and policy changes. The objective of this study was to examine the characteristics of these collaborative groups and the extent to which they have achieved change. METHODS: We identified, recruited, and interviewed the coordinators of active living collaborative groups in the United States. We used descriptive statistics to characterize groups by composition, stakeholder engagement, and the extent of environmental and policy change in 8 strategic areas. RESULTS: Fifty-nine groups from 22 states participated in the study. Most groups had a diverse set of partners and used a range of activities to advance their agendas. Most groups achieved some form of environmental or policy change. On average, groups reported working on 5 strategy areas; parks and recreation (86%) and Safe Routes to School (85%) were named most frequently. More than half of groups reported their environmental initiatives as either in progress or completed. Groups reported the most success in changing policy for public plazas, street improvements, streetscaping, and parks, open space, and recreation. Complete Streets policy and zoning ordinances were the most frequently cited policy types. Engaging in media activities and the policy-making process in addition to engaging stakeholders appear to influence success in achieving change. CONCLUSION: Although many groups successfully worked on parks and recreation improvements, opportunities remain in other areas, including transit and infill and redevelopment. Additional time and resources may be critical to realizing these types of changes.