Supporting Faith-Based Communities Through and Beyond the Pandemic.

The COVID-19 pandemic brought widespread and notable effects to the physical and mental health of communities across New York City with disproportionate suffering Black/African American and Hispanic/Latino communities alongside additional stressors such as racism and economic hardship. This report describes the adaptation of a previously successful evidence-based community engagement health education program for the deployment of resilience promoting workshop program in faith-based organizations in BIPOC communities in New York City. From June 2021 to June 2022, nine faith-based organizations implemented 58 workshops to 1,101 non-unique workshop participants. Most of the workshops were delivered online with more women (N = 803) than men (N = 298) participating. All organizations completed the full curriculum; the workshop focused on self-care and physical fitness was repeated most frequently (N = 13). Participants in the workshops ranged from 4 to 73 per meeting and were largely female. The Building Community Resilience Project is an easy and effective way to modify an existing, evidence-based community health education program to address new and relevant health needs such as resilience and stress amidst the COVID-19 pandemic among faith communities serving BIPOC populations. More research is needed regarding the impact of the workshops as well as adaptability for other faith traditions.

Barriers and opportunities to measuring oncology patient navigation impact: Results from the National Navigation Roundtable survey.

BACKGROUND: Patient navigation improves cancer care delivery for those most at risk for poor outcomes. Lack of sustainable funding threatens the full integration of navigation services into health care delivery systems. Standardized navigation metrics that document impact and identify best practices are necessary to support sustainability. METHODS: The National Navigation Roundtable administered a web-based, cross-sectional survey to oncology patient navigation programs to identify barriers and facilitators to the use of navigation metrics. The 38-item survey asked about data-collection practices and specific navigation metrics used by the program. Exploratory and descriptive statistics were used to identify factors associated with data collection and reporting. RESULTS: Seven hundred fifty respondents from across the country represented navigation programs across the continuum of care. Although 538 respondents (72%) reported participating in routine data collection, only one-half of them used data for reporting purposes. For the 374 programs that used electronic health records, only 40% had discrete, reportable navigation fields, and 25% had an identifier for navigated patients. Program funding was identified as the only characteristic associated with data collection, whereas the type of data collected was associated with work setting, participation in alternative payment models, and where on the continuum navigation services are provided. Respondents participating in an oncology accreditation program were more likely to collect specific outcome metrics across the continuum and to use those data for reporting purposes. The most common barriers to data collection were time (55%) and lack of support for complex data systems and/or platforms (50%). CONCLUSIONS: Inconsistent data collection and reporting of oncology navigation programs remain a threat to sustainability. Aligning data collection with oncology accreditation, funding, and reimbursement is a viable path forward.

Community Partnership in Precision Medicine: Themes from a Community Engagement Conference.

Background: Patient and community engagement in under-resourced communities is a key issue for precision medicine research. We report proceedings from a community-academic partnered conference in Los Angeles to promote community understanding of precision medicine and generate engagement recommendations. Methods: Planning group review of planning, presentations, and audience discussions from facilitator notes and participant survey data from a one-day conference. Findings: Community-academic planning broadened community participation and presentations. More than 80% of survey participants indicated they would participate in the national precision medicine initiative, and most were willing to share diverse sources of data. Discussions identified trust concerns related to historical research abuses, data privacy, potential effects of findings on health care, personal safety, research procedures, the time-frame for benefit, and confusion about different initiatives. Concerns were balanced by belief in science to improve health. Recommendations included a community partnered participatory approach with support for local community and academic teams to engage stakeholders with written/online resources and partnered workgroups addressing key concerns. Conclusion: Conference participants expressed high willingness to participate in precision medicine studies, but discussions highlighted trust and transparency issues and suggested community partnered research with local capacity building.

The Healthy Community Neighborhood Initiative: Rationale and Design.

OBJECTIVE: To describe the design and rationale of the Healthy Community Neighborhood Initiative (HCNI), a multi-component study to understand and document health risk and resources in a low-income and minority community. DESIGN: A community-partnered participatory research project. SETTING: A low-income, biethnic African American and Latino neighborhood in South Los Angeles. PARTICIPANTS: Adult community residents aged >18 years. MAIN OUTCOME MEASURES: Household survey and clinical data collection; neighborhood characteristics; neighborhood observations; and community resources asset mapping. RESULTS: We enrolled 206 participants (90% of those eligible), of whom 205 completed the household interview and examination, and 199 provided laboratory samples. Among enrollees, 82 (40%) were aged >50 years and participated in functional status measurement. We completed neighborhood observations on 93 street segments; an average of 2.2 (SD=1.6) study participants resided on each street segment observed. The community asset map identified 290 resources summarized in a Community Resource Guide given to all participants. CONCLUSIONS: The HCNI community-academic partnership has built a framework to assess and document the individual, social, and community factors that may influence clinical and social outcomes in a community at high-risk for preventable chronic disease. Our project suggests that a community collaborative can use culturally and scientifically sound strategies to identify community-centered health and social needs. Additional work is needed to understand strategies for developing and implementing interventions to mitigate these disparities.

The Current Status of Telehealth and Distance Learning in Palau.

In 2017 the Republic of Palau installed fiber optic cables, allowing access to high speed internet for the first time and the capacity for growth in telehealth. Given Palau's poor access to specialists and resources, telehealth has the potential to radically change health care delivery. Currently, the status of telehealth in Palau is unknown. This study describes telehealth resources utilized at the Ministry of Health in Palau and potential future directions for telehealth. Thirty-four people, mostly health professionals at the Belau National Hospital in Palau were interviewed, including physicians, information technology personnel, public health department staff, department managers of allied health, and telehealth experts in the Pacific. Standardized questions and surveys were conducted in-person during July 2019. All departments utilized some form of telehealth. Common needs for the advancement of telehealth included: a telehealth champion, a resource facilitator, successful distance learning for auxiliary staff, dedicated telehealth space, technological help, and better telehealth communication with rural clinics. Survey respondents indicated that they would like to use some sort of distance learning, most commonly for professional betterment (86%) and upskilling of staff (86%). There are numerous distance learning and telehealth opportunities available, yet recurrent barriers to these opportunities were noted across all departments. The barriers identified in the current study and recommendations to overcome them may be applicable to other Pacific nations who face similar challenges.

Community Assessment for a Low-Carbohydrate Nutrition Education Program in South Africa.

Eat Better South Africa (EBSA) is an organization that provides low-carbohydrate, high-fat (LCHF) nutrition and health education programs for women from under-resourced South African communities. Community assessments are essential to explore participants' potential facilitators and challenges of adhering to new dietary behaviours and should be implemented before any dietary interventions. This study is a qualitative community assessment to enable the EBSA program to better meet potential participants' needs and explore their willingness to enrol in the EBSA program. Sixty women from two communities in the Western Cape were interviewed through six focus group discussions. A thematic analysis was conducted using NVivo 12 software, and four themes were developed around the women's (1) role within the households; (2) dietary behaviour; (3) health perceptions; and (4) willingness to participate in an LCHF program. Women mentioned that they were responsible for cooking and shopping for their households. They expressed their understanding of healthy and unhealthy behaviours and their dietary patterns. Some women showed concerns about LCHF diets, but others wanted to learn more due to their knowledge of other people's positive experiences with the diet. There was a general desire to become healthy. However, the women anticipated dietary behaviour change to be challenging. Those challenges mostly revolved around their socioeconomic environments. The findings are intended to inform EBSA (or other nutrition interventions) on what to consider when implementing their interventions in these communities.

Ethical Considerations from Child-Robot Interactions in Under-Resourced Communities.

Recent advancements in socially assistive robotics (SAR) have shown a significant potential of using social robotics to achieve increasing cognitive and affective outcomes in education. However, the deployments of SAR technologies also bring ethical challenges in tandem, to the fore, especially in under-resourced contexts. While previous research has highlighted various ethical challenges that arise in SAR deployment in real-world settings, most of the research has been centered in resource-rich contexts, mainly in developed countries in the 'Global North,' and the work specifically in the educational setting is limited. This research aims to evaluate and reflect upon the potential ethical and pedagogical challenges of deploying a social robot in an under-resourced context. We base our findings on a 5-week in-the-wild user study conducted with 12 kindergarten students at an under-resourced community school in New Delhi, India. We used interaction analysis with the context of learning, education, and ethics to analyze the user study through video recordings. Our findings highlighted four primary ethical considerations that should be taken into account while deploying social robotics technologies in educational settings; (1) language and accent as barriers in pedagogy, (2) effect of malfunctioning, (un)intended harms, (3) trust and deception, and (4) ecological viability of innovation. Overall, our paper argues for assessing the ethical and pedagogical constraints and bridging the gap between non-existent literature from such a context to evaluate better the potential use of such technologies in under-resourced contexts.

The Chaeli Campaign Journal Club: Strengthening evidence-based practice and contributing to practice-based evidence in under-resourced South African communities.

Background: The Chaeli Campaign is a Cape Town based non-profit organisation offering programmes largely for children and youth with disabilities in diverse under-resourced communities in South Africa. Their therapy team established a Health Professions Council of South Africa accredited interdisciplinary journal club in January 2012, with the aim to improve the team's service to the community. Objectives: Our first objective was to make our practice more evidence-based through reading systematically and critically in our field. Our second objective was to write up and share some of our practices to contribute to the generation of practice-based evidence. Method: First-person action research was applied. The core group of participants over time comprised two occupational therapists, one physiotherapist, two speech therapists, two teachers and four community development workers. Nine iterative cycles of planning, action, review and revised planning have been implemented on an annual basis in this non-formal, long-term action research project. Results: For over nine and a half years we have pre-read, discussed and completed evaluation questionnaires on 54 peer-reviewed journal articles, conducted 12 conference presentations and published three articles in accredited journals. Participants reported a broadened understanding of issues around disability, more reflective, contextually and culturally appropriate practice and improved interdisciplinary teamwork. Conclusion: The Chaeli Campaign journal club has built the capacity of therapists, teachers and community development workers to find, read, evaluate and use research evidence to improve their practice. It has also given participants the opportunity to ethically research, present and write up their grass roots interventions, thus contributing to locally applicable practise-based evidence. It is hoped that the sharing of our experience will assist and encourage other teams to start interdisciplinary journal clubs as a step towards facilitating two-way knowledge translation from evidence to practice and from practice to evidence.

Community-based rehabilitation implementation framework to address patellofemoral pain amongst runners in under-resourced communities: Delphi consensus.

BACKGROUND: Runners in under-resourced communities in parts of South Africa present with a high prevalence of patellofemoral pain (PFP), which affects their level of participation in sporting activities. Therefore, a specific rehabilitation approach is necessary to manage the PFP-related needs of these runners within their means and reach. OBJECTIVE: To develop a community-based rehabilitation (CBR) implementation framework for PFP amongst runners in under-resourced communities. METHOD: Our study used the Delphi technique to develop an appropriate rehabilitation implementation framework for PFP in community-based settings. Sport medicine experts, involved in the treatment and rehabilitation of PFP, were recruited to participate. The Delphi process consisted of three rounds to attain consensus amongst the experts on the components and elements that could be contained in a rehabilitation implementation framework for the management of PFP. Experts rated the framework items using a five-point Likert scale. RESULTS: A total of 19 experts participated in our study: 10 were females and 9 were males of whom 13 were aged between 36 and 55 years. Most were local experts (15) with 11-20 years of clinical experience. Four core rehabilitation implementation items were identified through the Delphi process. These were: (1) the establishment of transdisciplinary rehabilitation teams, (2) upskilling of available clinicians, their assistants and trainers, (3) implementation of a CBR programme at low-level or no-cost and (4) referral of cases to secondary or tertiary institutions for further management. CONCLUSION: Consensus was reached for a comprehensive CBR implementation framework aimed at addressing the specific needs of runners with PFP in under-resourced communities. CLINICAL IMPLICATIONS: A further study to test the feasibility of the agreed-upon intervention is recommended.

Exploring the Perceptions of Women from Under-Resourced South African Communities about Participating in a Low-Carbohydrate High-Fat Nutrition and Health Education Program: A Qualitative Focus Group Study.

Scientific evidence suggests that low-carbohydrate high-fat (LCHF) diets may be effective for managing non-communicable diseases (NCDs). Eat Better South Africa (EBSA) is an organization that runs LCHF nutrition education programs for women from low-income communities. Three focus group discussions (FGDs) were held with 18 women who had taken part in an EBSA program between 2015 and 2017, to explore their perceptions and to identify the facilitators and barriers they faced in implementing and sustaining dietary changes. Thematic analysis of the focus groups was conducted using NVivo 12 software. Women reported that they decided to enroll in the program because they suffered from NCDs. Most women said that the EBSA diet made them feel less hungry, more energetic and they felt that their health had improved. Most women spoke of socioeconomic challenges which made it difficult for them to follow EBSA's recommendations, such as employment status, safety issues in the community, and lack of support from relatives and doctors. Hence, women felt they needed more support from EBSA after the program. The social determinants that affected these women's ability to change their health behavior are also NCD risk factors, and these should be assessed to improve the program for other communities.

Exploring Key Elements for Successful Telehealth Implementation Within Severely Under-Resourced Communities: A Case Study in the Pacific Islands.

The intent of this paper is to identify and provide insight on key enablers for successful implementation of telehealth services in severely under-resourced and rural populations. The case study presented is in the context of the U.S. Affiliated Pacific Islands that represent resilient and innovative communities who face many challenges of isolation, tiny populations, and developing economies. Long-standing telecommunication hindrances and lack of supporting resources are fundamental barriers to telehealth advancement. New undersea fiber optic developments present opportunities for reliable connectivity needed for telehealth applications. This paper reviews the emergence of telehealth champions in the region and reviews key elements that contribute to rapid and successful implementation of telehealth applications and services.

A Pilot Study Promoting Participation of Families with Limited Resources in Early Autism Intervention.

BACKGROUND: Relatively little research about autism early intervention has occurred in families of low socioeconomic status. Barriers to participation for under-resourced families (i.e., families with low incomes or limited education), pose a significant problem. The purpose of this pilot study was to apply empirically supported methods promoting participation of families with low-income and low-education levels to an established intervention for children with autism spectrum disorder (ASD). METHOD: Participant recruitment specifically targeted families whose income was equal to or below two times the federal poverty line and whose caregiver(s) had no more than two years of college attendance. An evidence-based intervention was modified to be more accessible to participating families. Adaptations focused on decreasing access barriers, decreasing attrition, and promoting positive change within families. Success of the program was measured quantitatively and qualitatively. RESULTS: Twenty-seven families were referred to the project, 13 of which did not meet eligibility requirements. Eight families enrolled, maintained participation for the majority of the project and provided positive qualitative feedback of their experiences. Project and treatment attrition were calculated at 62% and 12.5%, respectively. Treatment attendance was high, but length of time to complete treatment was greatly influenced by the number of session cancellations. CONCLUSIONS: The exploratory project demonstrated that practical modifications to standard early intervention protocols can promote engagement in families with limited resources. Recommendations for programs seeking to implement interventions in under-resourced communities are discussed.