Migração em tempos de covid-19: impactos e estratégias de enfrentamento / Migration in times of covid-19: effects and coping strategies / Migración en tiempos del covid-19: impactos y estrategias de afrontamiento

Em 2020, o mundo enfrentou uma grave emergência de saúde pública devido à pandemia de COVID-19, que impactou significativamente a mobilidade humana e a vida cotidiana de milhares de imigrantes ao redor do mundo. Este artigo fez uso de entrevistas online e por telefone com imigrantes que chegaram ao Brasil a partir de 2016, para identificar as estratégias de enfrentamento adotadas durante a pandemia. Foi realizada uma análise transversal das entrevistas com o auxílio do software Atlas.ti 9, usando a técnica sistemática de categorização iterativa. Com base em uma perspectiva sociocultural em psicologia, o artigo introduz os impactos iniciais da pandemia em diferentes esferas da vida cotidiana desses imigrantes e apresenta as estratégias mobilizadas para restaurar continuidades funcionais e relacionais em um momento no qual as rupturas provocadas pela migração e pela pandemia se sobrepõem. Entre outros, podese identificar como os entrevistados ativaram rapidamente as redes sociais locais e transnacionais virtualmente, mobilizando competências e habilidades aprendidas durante a migração.(AU)

In 2020, the world faced a serious public health emergency due to the COVID-19 pandemic, which has significantly impacted human mobility and the daily lives of thousands of immigrants around the world. This article uses online and telephone interviews conducted with migrants who arrived in Brazil in 2016, to identify coping strategies employed during the pandemic. A transversal analysis of all interviews was conducted with the aid of the software Atlas.ti 9, using a systematic approach of iterative categorization. From a sociocultural perspective in psychology, the article introduces the initial impacts of the pandemic in different spheres of everyday life of these immigrants. With this everyday context, we present the strategies mobilized by immigrants to restore functional and relational continuities at a moment in which the ruptures caused by migration and the pandemic overlap. In particular, we identify how interviewees rapidly activated local and transnational social networks virtually, mobilizing skills learnt during migration.(AU)

En 2020, el mundo se enfrentó a un grave estado de emergencia en salud pública debido a la pandemia del COVID-19, que impactó significativamente la movilidad humana y la vida cotidiana de miles de inmigrantes en todo el mundo. Este artículo realizó entrevistas en línea y por teléfono con inmigrantes quienes llegaron a Brasil a partir de 2016, con el fin de identificar sus estrategias de afrontamiento adoptadas durante la pandemia. Se realizó un análisis transversal de las entrevistas con la ayuda del software Atlas.ti 9, utilizando la técnica sistemática de categorización iterativa. Desde una perspectiva sociocultural en Psicología, este artículo expone los impactos iniciales de la pandemia en diferentes ámbitos de la vida cotidiana de estos inmigrantes y presenta las estrategias movilizadas para restaurar las continuidades funcionales y relacionales en un momento en que se superponen las rupturas causadas por la migración y la pandemia. Entre otros aspectos, se puede identificar cómo los entrevistados activaron virtualmente las redes sociales locales y transnacionales movilizando habilidades y destrezas aprendidas durante la migración.(AU)

Cluster-randomized trial comparing organizationally tailored versus standard approach for integrating an evidence-based cancer control intervention into African American churches.

The field of implementation science has devoted increasing attention to optimizing the fit of evidence-based interventions to the organizational settings in which they are delivered. Institutionalization of health promotion into routine organizational operations is one way to achieve this. However, less is known about how to maximize fit and achieve institutionalization, particularly in settings outside of the healthcare system. This paper reports on findings from a parallel cluster-randomized trial that compared an organizationally tailored with a standard (core components only) approach for institutionalizing ("integrating") an evidence-based cancer control intervention into African American churches. Churches randomized to the organizationally tailored condition identified three or more implementation strategies from a menu of 20, with an implementation time frame for each. The primary study outcome was assessed through the Faith-Based Organization Health Integration Inventory, a measure of institutionalization of health promotion activities in church settings, completed by pastors at baseline and 12-month follow-up. Seventeen churches were randomized and 14 were analyzed as 3 did not implement the study protocol. Though the percent increase in total integration score was greater in the tailored condition (N = 9; 18%) than in the standard condition (N = 5; 12%), linear mixed-effect models did not detect a statistically significant group × time interaction. Despite the challenges of integrating health promotion activities outside of healthcare organizations, the current approach shows promise for fostering sustainable health promotion in community settings and merits further study.

Researchers have become interested in studying how health promotion activities fit within the organizational setting where they are delivered. Health activities that are integrated into the host setting's structures and routine operations are more likely to be fully executed, effective, and sustained. Unfortunately, we know little about how to achieve such integration. This is especially true when working outside of a healthcare system, in community organizations like churches. We report findings from a study that compared an approach to tailoring health promotion activities into their host settings, with a standard, non-tailored approach. The study was conducted in 14 African American churches randomly assigned to the tailored or standard group. The health promotion activity involved training lay people to conduct cancer educational workshops for church members. We measured the extent to which the churches integrated health promotion activities into their structures, processes, resources, and communication at the beginning and one year later. We found that while the churches had overall increases in these factors over time, those in the tailored group did not do so to a greater degree than those in the standard group. Even so, this approach to tailoring health promotion activities to the organizational setting merits future study.

The Evolving Landscape of Global Surgery: A Qualitative Study of North American Surgeons' Perspectives on Faith-Based and Academic Initiatives.

Faith-based missions have played a large role in surgical care delivery in low- and middle-income countries (LMIC). As global surgery is now an academic discipline, this pilot study sought to understand how different faith ideologies influence surgeon motivations and subsequent culture of the global surgery landscape. Interviews were conducted with North American surgeons who pursue global surgery significantly in their career. Points of discussion included early influences, obstacles, motivations, philosophy and approach to global surgery work, and experiences with faith-based (FBO) and non-faith-based organizations (NFBO). Notes were transcribed and thematic analysis performed. Sixteen surgeons were interviewed (11 men, 5 women, ages 39-75 years-old). Surgeons had worked in 32 countries with FBO and NFBO in intermittent or long-term capacity. Religious upbringing and current affiliations included Atheism, Protestant Christianity, Catholicism, Hinduism, Judaism, Mormonism, Islam, and nonreligious spirituality. Early influences included international upbringing (n = 7), emphasis on service (n = 9), and exposure to the religious mission concept (n = 6). The most common core motivation among all participants was addressing disparities (n = 10). Some believed that FBO and NFBO have different goals (n = 4), and only surgeons identifying with Christianity believed the goals are similar (n = 3). Participants expressed that FBO are exclusive (n = 4) and focused on proselytization (n = 6) while NFBO are humanitarian (n = 3) but less integrated into the community (n = 4). Global surgeons have shared early influences, obstacles, and desire to address disparities. Perceptions of FBO and NFBO differed based on religious background. This pilot study will inform future studies regarding the collaborations of FBO and NFBO to improve global surgical care.

M.I.C.A.H. Project HEAL: Sustainability of a Faith-Based Community Health Advisor Training Program in Urban Underserved Communities in the USA.

Faith-based organizations (FBOs) can play an important role in improving health outcomes. Lay community health advisors (CHAs) are integral to these efforts. This paper assesses the sustainability of a CHA training program for congregants in African-American and Latino FBOs and subsequent implementation of educational workshops. The program is unique in that a health care chaplain in an academic medical center was central to the program's development and implementation. Forty-eight CHAs in 11 FBOs were trained to teach workshops on cardiovascular health, mental health, diabetes, and smoking cessation. Two thousand four hundred and forty-four participants attended 70 workshops. This program has the potential to be a model to educate individuals and to address health inequities in underserved communities. Health care chaplains in other medical centers may use this as a model for enhancing community engagement and education.

Awareness, knowledge and screening for cervical cancer among women of a faith-based organization in Nigeria.

INTRODUCTION: cervical cancer is the second most frequent cancer among women in Nigeria. With proper screening, the disease can be detected early enough and properly managed. However, there seems to be limited knowledge of cervical cancer among women and several barriers might prevent them from accessing the screening services. We determined the awareness, knowledge and screening for cervical cancer among women of a faith-based organization in Nigeria. METHODS: we employed descriptive survey research design and purposively sampled a Catholic Parish in Nsukka Local Government Area of Enugu State, Nigeria. All consenting women in the Parish were used for the study. We utilized researchers' structured instrument titled 'Awareness and knowledge about Cervical Cancer and Screening' to collect data. Frequencies, percentages and logistic regression were employed for data analysis. RESULTS: awareness of cervical cancer (70.8%) and its screening (68.1%) are high but there is generally poor level of knowledge (65.3%) of different aspects of cervical cancer among the women. Age (aOR: 7.183, 95% CI 1.769-29.168; p=.006), number of children (aOR: .074, 95% CI .009- .631; p=.017), and occupation (aOR: .032, 95% CI .004-.260; p= .001 and aOR: .050, 95% CI .007-.347; p=.002) were significantly associated with knowledge of cervical cancer. Majority of the women studied had never been screened for cervical cancer (91.7%) and the reasons for not screening ranged from lack of knowledge of; where to go for screening (69.7%) and the importance of being screened (40.9%) to not feeling susceptible to cervical cancer (18.2%). CONCLUSION: there was generally poor knowledge of cervical cancer and its screening; and very poor screening practice. There is, therefore, an urgent need to improve women´s knowledge of cervical cancer and address the identified barriers in order to improve screening practices of the women.

Religion and the World Health Organization: an evolving relationship.

Much has been written about WHO. Relatively little is known, however, about the organisation's evolving relationship with health-related personal beliefs, 'faith-based organisations' (FBOs), religious leaders and religious communities ('religious actors'). This article presents findings from a 4-year research project on the 'spiritual dimension' of health and WHO conducted at the University of Zürich. Drawing on archival research in Geneva and interviews with current and former WHO staff, consultants and programme partners, we identify three stages in this relationship. Although since its founding individuals within WHO occasionally engaged with religious actors, it was not until the 1970s, when the primary healthcare strategy was developed in consultation with the Christian Medical Commission, that their concerns began to influence WHO policies. By the early 1990s, the failure to roll out primary healthcare globally was accompanied by a loss of interest in religion within WHO. With the spread of HIV/AIDS however, health-related religious beliefs were increasingly recognised in the development of a major quality of life instrument by the Division of Mental Health, and the work of a WHO expert committee on cancer pain relief and the subsequent establishment of palliative care. While the 1990s saw a cooling off of activities, in the years since, the HIV/AIDS, Ebola and COVID-19 crises have periodically brought religious actors to the attention of the organisation. This study focusses on what we suggest may be understood as a trend towards a closer association between the activities of WHO and religious actors, which has occurred in fits and starts and is marked by attempts at institutional translation and periods of forgetting and remembering.

Program Implementation and Church Members' Health Behaviors in a Countywide Study of the Faith, Activity, and Nutrition Program.

Implementation research of health programs in faith-based organizations is lacking. The Faith, Activity, and Nutrition (FAN) program helps churches improve physical activity and fruit and vegetable behaviors of members. This study examined associations between implementation of FAN intervention components and church members' physical activity, fruit and vegetable behaviors, and self-efficacy for improving these behaviors. FAN was implemented in 35 churches in a southeastern US county. After attending in-person training, led by community health advisors, church committees received 12 months of telephone-delivered technical assistance to implement FAN according to 4 components: increasing opportunities, increasing guidelines and policies, increasing pastor support, and increasing messages for physical activity and healthy eating in their church. In this correlational study, FAN coordinators (n = 35) for each church reported baseline practices in 2015 and 12-month follow-up implementation of the 4 components for physical activity and healthy eating in 2016. Church members (n = 893) reported perceived implementation, physical activity and fruit and vegetable behaviors, and self-efficacy at 12-month follow-up in 2016. Independent variables were coordinator-reported baseline practices, baseline-adjusted 12-month implementation, and member-perceived 12-month implementation. Multilevel modeling examined associations between independent variables and member-reported 12-month physical activity and fruit and vegetable behaviors and self-efficacy. Coordinator-reported 12-month implementation of fruit and vegetable opportunities was associated with member fruit and vegetable consumption. Member perceptions at 12 months of church physical activity opportunities, pastor support, and messages were associated with higher self-efficacy for physical activity; pastor support and messages were positively associated with physical activity. Member perceptions at 12 months of fruit and vegetable opportunities, pastor support, and messages were associated with higher fruit and vegetable consumption and self-efficacy. Member-perceived implementation was more strongly associated with member behaviors than coordinator-reported implementation. Providing opportunities for healthy eating during already scheduled events may be an effective strategy for improving fruit and vegetable behavior.

Key considerations for designing capacity-building interventions to support evidence-based programming in underserved communities: a qualitative exploration.

Increasing the use of evidence-based programs (EBPs) in community settings is critical for improving health and reducing disparities. Community-based organizations (CBOs) and faith-based organizations (FBOs) have tremendous reach and trust within underserved communities, but their impact is constrained by limited staff capacity to use EBPs. This exploratory study sought to identify design and delivery considerations that could increase the impact of capacity-building interventions for CBOs and FBOs working with underserved communities. Data come from a community-based participatory research project addressing cancer disparities in Black, Latino, and Brazilian communities from Greater Boston and Greater Lawrence, Massachusetts. We conducted four focus group discussions with program coordinators in CBOs and FBOs (n = 27) and key informant interviews with CBO and FBO leaders (n = 15). Three researchers analyzed the data using a multi-stage coding process that included both prefigured and emergent codes. Key design considerations included embedding customized capacity-building interventions into community networks with local experts, supporting ongoing engagement with the intervention via a range of resources and communication channels, and addressing resource constraints. Regarding the contextual factors that should influence capacity-building intervention content, participants highlighted resource constraints, environments in which EBP use is not the norm, and challenges linking available programs with the multi-level barriers to good health faced by community members. Overall, the study highlights the need for integrated, long-term capacity-building efforts developed in partnership with, and ultimately sustained by, local organizations.

Examining the external validity of the CRUZA study, a randomized trial to promote implementation of evidence-based cancer control programs by faith-based organizations.

The CRUZA trial tested the efficacy of an organizational-level intervention to increase capacity among Catholic parishes to implement evidence-based interventions (EBIs) for cancer control. This paper examines the external generalizability of the CRUZA study findings by comparing characteristics of parishes that agreed to participate in the intervention trial versus those that declined participation. Sixty-five Roman Catholic parishes that offered Spanish-language mass in Massachusetts were invited to complete a four-part survey assessing organization-level characteristics that, based on the Consolidated Framework for Implementation Research (CFIR), may be associated with EBI implementation. Forty-nine parishes (75%) completed the survey and were invited to participate in the CRUZA trial, which randomized parishes to either a "capacity enhancement intervention" or a "standard dissemination" group. Of these 49 parishes, 31 (63%) agreed to participate in the trial, whereas 18 parishes (37%) declined participation. Parishes that participated in the CRUZA intervention trial were similar to those that did not participate with respect to "inner organizational setting" characteristics of the CFIR, including innovation and values fit, implementation climate, and organizational culture. Change commitment, a submeasure of organizational readiness that reflects the shared resolve of organizational members to implement an innovation, was significantly higher among the participating parishes (mean = 3.93, SD = 1.08) as compared to nonparticipating parishes (mean = 3.27, SD = 1.08) (Z = -2.16, p = .03). Parishes that agreed to participate in the CRUZA intervention trial were similar to those that declined participation with regard to organizational characteristics that may predict implementation of EBIs. Pragmatic tools to assess external generalizability in community-based implementation trials and to promote readiness among faith-based organizations to implement EBIs are needed to enhance the reach and impact of public health research. Clinical Trial information: The CRUZA trial identifier number with clinicaltrials.gov is NCT01740219.

Role of a Community-based Program for Identification and Referral of Pediatric Cataract Patients in Kinshasa, Democratic Republic of the Congo.

PURPOSE: The purpose of this study is to describe the methodology and to assess the effectiveness of a community-based rehabilitation (CBR) program to identify and refer children with blinding cataract for the management and surgery to reduce the burden of childhood blindness due to cataract in Kinshasa. METHODS: Church-based volunteers were trained to identify children with presumed eye disorders in their localities and households and to refer them for cataract identification by an ophthalmic nurse during parishes' visits. Volunteers were parishioners living in the quartiers where identification took place and worked as community workers with the CBR program. Nurses used a lamp-torch to rule out cataract. Selected children were referred to the tertiary eye health facility at St Joseph Hospital for diagnosis and management. RESULTS: Identification took place in 31 out of 165 parishes in the Archdioceses of Kinshasa from 2000 to 2016 and 11,106 children aged <16 years were screened. Among them, 1277 children (11.5%) were presumed to have cataract. Ninety-two children among them died before surgery; 107 children were lost to further follow-up and did not report to the CBR center for referral. Reasons given were change of home address, moving in their lieu of origin, death, and refusal of treatment by the parents. Finally, only 1078 children were referred to the pediatric ophthalmologist and 705 children (65.4%) were definitively diagnosed to have treatable cataract, while in 373 children (34.6%), cataract surgery was not indicated for several reasons. There was a positive history of familial cataract in 36 children (2.8%). CONCLUSION: Using church-based volunteers and ophthalmic nurses during community screening proved efficient in the identification and referral of pediatric cataract. Keeping regular identification activities in the community and maintaining high-quality and accessible pediatric cataract surgery services can help to clear up the backlog of cataract blind children.

A religiously-tailored, multilevel intervention in African American churches to increase HIV testing: Rationale and design of the Taking It to the Pews cluster randomized trial.

HIV continues to disproportionately impact African American (AA) communities. Due to delayed HIV diagnosis, AAs tend to enter HIV treatment at advanced stages. There is great need for increased access to regular HIV testing and linkage to care services for AAs. AA faith institutions are highly influential and have potential to increase the reach of HIV testing in AA communities. However, well-controlled full-scale trials have not been conducted in the AA church context. We describe the rationale and design of a 2-arm cluster randomized trial to test a religiously-tailored HIV testing intervention (Taking It to the Pews [TIPS]) against a standard information arm on HIV testing rates among AA church members and community members they serve. Using a community-engaged approach, TIPS intervention components are delivered by trained church leaders via existing multilevel church outlets using religiously-tailored HIV Tool Kit materials and activities (e.g., sermons, responsive readings, video/print testimonials, HIV educational games, text messages) to encourage testing. Church-based HIV testing events and linkage to care services are conducted by health agency partners. Control churches receive standard, non-tailored HIV information via multilevel church outlets. Secondarily, HIV risk/protective behaviors and process measures on feasibility, fidelity, and dose/exposure are assessed. This novel study is the first to fully test an HIV testing intervention in AA churches - a setting with great reach and influence in AA communities. It could provide a faith-community engagement model for delivering scalable, wide-reaching HIV prevention interventions by supporting AA faith leaders with religiously-appropriate HIV toolkits and health agency partners.

Prediction of maximal oxygen consumption using the Young Men's Christian Association-step test in Korean adults.

PURPOSE: To develop accurate and practical prediction models of maximal oxygen consumption (VO2max) using the Young Men's Christian Association (YMCA)-step test in South Korean adults. METHODS: In total, 568 adults (20-66 years) were included in this study. To develop and cross-validate prediction models of VO2max, the total sample was divided into 80% training and 20% testing using a simple random sampling method. VO2max was measured using the maximal-graded exercise treadmill test. Sex, age, 1-min recovery heart rate, body weight, and height were measured as potential predictors. Each test was conducted within a 2- to 3-day interval, ensuring sufficient rest. Preliminary prediction models were developed from training datasets, which were cross-validated using regression analyses and/or repeated-measures analysis of variance. The accuracy of prediction models was evaluated using R2, standard error of estimate (SEE), and mean difference (MD) against a criterion-measured VO2max. RESULTS: The average age and VO2max were 43.5 ± 12.9 years and 39.1 ± 7.5 ml/kg/min, respectively. For model development, three practical models with acceptable accuracy were developed (R2 = 0.56-0.61; SEE = 4.74-5.01). For model cross-validation, significant relationships between the criterion-measured and predicted VO2max were observed in all three models (R2 = 0.56-0.61; SEE = 4.62-4.88). The difference between criterion-measured and predicted VO2max was not significant in the models (MD =- 0.03 to - 0.14). CONCLUSIONS: The prediction models included 3-5 variables as significant predictors of VO2max and had acceptable accuracy in a large sample of South Korean adults. The selected models provide a simple and practical method to estimate VO2max using the YMCA-step test for South Korean adults.

A Culturally Sensitive Church-Based Health-Smart Intervention for Increasing Health Literacy and Health-Promoting Behaviors among Black Adult Churchgoers.

The purpose of the paper is to examine the effectiveness of a six-week, culturally sensitive, church-based health-promotion intervention in increasing nutrition label health literacy and health-promoting behaviors (i.e., healthy eating, healthy drinking, and physical activity) and improving weight and blood pressure among Black adults. Study participants are a sample of 321 Black adult churchgoers (N = 321) who were divided between an intervention group (N = 172) and a wait-list control group (N = 149). The health-promotion intervention program is informed by Health Self-Empowerment Theory. At post-test, the participants in the intervention group demonstrated significantly greater increases in nutrition label health literacy, overall level of engagement in health-smart behaviors, and levels of engagement in two specific health-smart behaviors (i.e., healthy eating and healthy drinking) compared with those in the wait-list control group. Implications of these findings for future similar health-promotion intervention programs and research are discussed.

Influencing cardiovascular health habits in the rural, deep south: results of a cluster randomized trial.

Cardiovascular disease (CVD) is a major cause of death among people living in the United States. Populations, especially minorities, living in the rural South are disproportionately affected by CVD and have greater CVD risk, morbidity and mortality. Culturally relevant cardiovascular health programs implemented in rural community settings can potentially reduce CVD risk and facilitate health behavior modification. The purpose of this study was to examine the effects of a cardiovascular health promotion intervention on the health habits of a group of rural African American adults. The study had a cluster randomized controlled trial design involving 12 rural churches that served as statistical clusters. From the churches (n = 6) randomized to the intervention group, 115 participants were enrolled, received the 6-week health program and completed pretest-posttest measures. The 114 participants from the control group churches (n = 6) did not receive the health program and completed the same pretest-posttest measures. The linear mixed model was used to compare group differences from pretest to posttest. The educational health intervention positively influenced select dietary and confidence factors that may contribute toward CVD risk reduction.

Church leaders' barriers and facilitators before and after implementing a physical activity and nutrition intervention.

Faith-based health promotion programs have been effective in increasing healthy eating (HE) and physical activity (PA). Very few reports exist regarding church leaders' anticipated and experienced barriers and facilitators to program implementation. Pastors (n = 38, 70%) and program coordinators (n = 54, 100%) from churches (N = 54) who attended a program training answered open-ended questions about anticipated barriers and facilitators to implementing the HE and PA parts of the Faith, Activity, and Nutrition (FAN) program. Twelve months later, pastors (n = 49, 92%) and coordinators (n = 53, 98%) answered analogous questions about their experienced barriers and facilitators to implementing the HE and PA parts of the FAN program. Responses were coded using thematic analysis. Similar themes appeared at baseline and follow-up for anticipated and experienced barriers and facilitators. The most common barriers were no anticipated barriers, resistance to change, church characteristics, and lack of participation/motivation. The most common facilitators were internal support, leadership, and communication. Few differences were found between anticipated and experienced barriers and facilitators. Understanding these perspectives, particularly overcoming resistance to change and church characteristics through strong leadership and internal support from church leaders, will improve future program development, resources, and technical assistance in faith-based and non-faith-based communities alike.

A Community-Partnered Approach to Developing Church-Based Interventions to Reduce Health Disparities Among African-Americans and Latinos.

Faith and public health partnerships offer promise to addressing health disparities, but examples that incorporate African-Americans and Latino congregations are lacking. Here we present results from developing a multi-ethnic, multi-denominational faith and public health partnership to address health disparities through community-based participatory research (CBPR), focusing on several key issues: (1) the multi-layered governance structure and activities to establish the partnership and identify initial health priority (obesity), (2) characteristics of the congregations recruited to partnership (n = 66), and (3) the lessons learned from participating congregations' past work on obesity that informed the development of a multi-level, multi-component, church-based intervention. Having diverse staff with deep ties in the faith community, both among researchers and the primary community partner agency, was key to recruiting African-American and Latino churches. Involvement by local health department and community health clinic personnel provided technical expertise and support regarding health data and clinical resources. Selecting a health issue-obesity-that affected all subgroups (e.g., African-Americans and Latinos, women and men, children and adults) garnered high enthusiasm among partners, as did including some innovative aspects such as a text/e-mail messaging component and a community mapping exercise to identify issues for advocacy. Funding that allowed for an extensive community engagement and planning process was key to successfully implementing a CBPR approach. Building partnerships through which multiple CBPR initiatives can be done offers efficiencies and sustainability in terms of programmatic activities, though long-term infrastructure grants, institutional support, and non-research funding from local foundations and health systems are likely needed.

Testing for Turkeys Faith-Based Community HIV Testing Initiative: An Update.

Testing for Turkeys (TFT) HIV/hepatitis C virus (HCV) and sexually transmitted infection (STI) testing initiative is a joint effort between Older Women Embracing Life (OWEL), Inc., a nonprofit faith-based community HIV support and advocacy organization; the Johns Hopkins University Regional Partner MidAtlantic AIDS Education and Training Center (MAAETC); and the University of Maryland, Baltimore JACQUES Initiative (JI), and is now in its 11th year of providing HIV outreach, testing, and linkage to care. Since 2008, the annual TFT daylong community HIV testing and linkage to care initiative has been held 2 weeks before Thanksgiving at a faith-based center in Baltimore, Maryland, in a zip code where one in 26 adults and adolescents ages 13 years and older are living with HIV (Maryland Department of Health, Center for HIV Surveillance, Epidemiology, and Evaluation, 2017). TFT includes a health fair with vendors that supply an abundance of education information (handouts, videos, one-on-one counseling) and safer sex necessities, including male and female condoms, dental dams, and lube. Nutritious boxed lunches and beverages are provided to all attendees and volunteers. Everyone tested for HIV who stays to obtain their results is given a free frozen turkey as they exit. The Baltimore City Health Department is on hand with a confidential no-test list (persons in the state already known to have HIV) to diminish retesting of individuals previously diagnosed with HIV. However, linkage to care is available to everyone: newly diagnosed individuals and those previously diagnosed and currently out of care.

Sentidos del trabajo religioso en contextos marcados por la violencia: estudio en un complejo de favelas en Río de Janeiro / Meanings of religious work in contexts marked by violence: a study in a complex of shantytowns in Rio de Janeiro

RESUMEN Este trabajo se propone comprender los sentidos del trabajo religioso en la prevención de la violencia y la recuperación de personas involucradas con actos ilícitos en un complejo de favelas de la ciudad de Río de Janeiro, Brasil. Se analizan la acción de entidades religiosas en el territorio, las visiones de sus líderes sobre su papel y el de su iglesia y sus representaciones sobre el territorio y sobre las personas que realizan actos violentos. Entre 2010 y 2012, desde un abordaje cualitativo, se realizó observación participante y se efectuaron entrevistas a líderes religiosos y "convertidos", cuyos relatos se abordaron a través de análisis de la enunciación. Los líderes resaltan la importancia de la acción de sus iglesias en una localidad precaria y violenta y los "convertidos" destacan el papel de la evangelización en su conversión religiosa. Sin embargo, las relaciones entre religión y violencia son complejas e incluyen varios tipos de trayectorias y comportamientos: si bien se destaca la fuerza del apoyo religioso, también se la cuestiona. Se concluye que las iglesias actúan de forma puntual e individual, por lo que colaboran poco con la transformación de la realidad, asumiendo con frecuencia un papel de control y de pacificación de la cuestión social.

ABSTRACT The purpose of this study is to understand the meanings of religious work in the prevention of violence and in the recovery of people involved in illicit acts in a complex of shantytowns in Rio de Janeiro, Brazil. The activities of religious entities in the territory, the view of religious leaders regarding their role and that of their church, and the representations of the territory and of the people who commit violent acts were analyzed. Using a qualitative approach, participant observation and interviews of religious leaders and "converts" were conducted between 2010 and 2012. The resulting narratives were treated using enunciation analysis. The leaders emphasize the importance of their churches' actions in violent and precarious areas, while the "converts" highlight the role of evangelization in their religious conversion. However, the relationships between religion and violence are complex, involving various types of trajectories and behaviors; in this way, the strength of religious support in the conversion process is both highlighted and questioned. The text concludes that churches' actions tend to be palliative and focused on the individual and therefore do little to transform reality, with the church potentially taking on roles of social control and pacification.

The role of perceived benefits and barriers in colorectal cancer screening in intervention trials among African Americans.

The Health Belief Model (HBM) is widely used in health behavior interventions. The lack of diverse samples in the development of this theory warrants additional study on how it performs among minorities. While studies have utilized HBM to address colorectal cancer (CRC) screening, limited information exists confirming how these constructs influence screening. Data from three CRC screening trials were used to examine how perceived benefits/barriers perform among African Americans (AA) and whether they serve as mechanisms of the intervention effects on screening. The data were collected in AA churches (Study 1: N = 103; Study 2: N = 285; Study 3: N = 374) where lay members conducted CRC education to increase screening. Participants perceived benefits from colonoscopy (M = 2.4/3, SD = 0.87) and perceived few barriers (M = 0.63/8, SD = 1.1). Benefits were perceived for the fecal occult blood test (M = 11.4/15, SD = 2.1), and few barriers were reported (M = 11.7/30, SD = 3.4). Benefits more consistently predicted pre-intervention screening relative to barriers. For Study 3, individuals with fewer barriers reported a greater increase in colonoscopy screening at 12-months versus those with higher barriers (OR = 0.595, 95% CI = 0.368-0.964), P = 0.035). Benefits/barriers did not mediate the relationship. Potential measurement limitations, particularly for barriers, were uncovered and further research on how to assess factors preventing AA from screening is needed.

Faith, Activity, and Nutrition Randomized Dissemination and Implementation Study: Countywide Adoption, Reach, and Effectiveness.

INTRODUCTION: Faith-based organizations can contribute to improving population health, but few dissemination and implementation studies exist. This paper reports countywide adoption, reach, and effectiveness from the Faith, Activity, and Nutrition dissemination and implementation study. DESIGN: This was a group-randomized trial. Data were collected in 2016. Statistical analyses were conducted in 2017. SETTING/PARTICIPANTS: Churches in a rural, medically underserved county in South Carolina were invited to enroll, and attendees of enrolled churches were invited to complete questionnaires (n=1,308 participated). INTERVENTION: Churches (n=59) were randomized to an intervention or control (delayed intervention) condition. Church committees attended training focused on creating opportunities, setting guidelines/policies, sharing messages, and engaging pastors for physical activity (PA) and healthy eating (HE). Churches also received 12 months of telephone-based technical assistance. Community health advisors provided the training and technical assistance. MAIN OUTCOMES MEASURES: The Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework guided measurement of adoption and reach. To assess effectiveness, church attendees completed post-test only questionnaires of perceptions of church environment, PA and fruit and vegetable (FV) self-efficacy, FV intake, and PA. Regression models controlled for church clustering and predominant race of congregation, as well as member age, gender, education, and self-reported cancer diagnosis. RESULTS: Church adoption was 42% (55/132). Estimated reach was 3,527, representing 42% of regular church attendees and 15% of county residents. Intervention church attendees reported greater church-level PA opportunities, PA and HE messages, and PA and HE pastor support (p<0.0001), but not FV opportunities (p=0.07). PA self-efficacy (p=0.07) and FV self-efficacy (p=0.21) were not significantly higher in attendees of intervention versus control churches. The proportion of inactive attendees was lower in intervention versus control churches (p=0.02). The proportion meeting FV (p=0.27) and PA guidelines (p=0.32) did not differ by group. CONCLUSIONS: This innovative dissemination and implementation study had high adoption and reach with favorable environmental impacts, positioning it for broader dissemination. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT02868866.