A scoping review of advanced pharmacy practice experience readiness assessment measures across schools of pharmacy.

BACKGROUND: The development and implementation of Advanced Pharmacy Practice Experience (APPE) readiness assessments has been an area of increased interest to the academy since the publication of the Accreditation Council for Pharmacy Education (ACPE) standards in 2016. This scoping literature review aims to provide an updated summary of current APPE readiness assessment practices among ACPE-accredited institutions in the United States (US). METHODS: A literature search was conducted between 2022 and 2024 using the terms "APPE student readiness," "APPE readiness assessment," "APPE preparedness," "APPE student preparedness," "pharmacy" AND "readiness assessment", "pharmacy" AND "practice readiness," and "pharmacy" AND "student practice readiness" in Pubmed and Embase. The websites for the American Journal of Pharmaceutical Education and Currents in Pharmacy Teaching and Learning were also searched using these terms. Abstracts for all results were reviewed. Abstract only and poster presentations were excluded, as well as articles centered on non-US and/or non-ACPE-accredited institutions. Data was collected regarding the outcomes assessed, type of assessment activity, and how the assessment was implemented. Results were reviewed by a second author to ensure consistency in reporting. RESULTS: A total of 289 unique abstracts were reviewed by author pairs for inclusion based on relevance to the review objectives. A total of 13 articles were included in the final analysis. Each institution measured different knowledge areas, abilities, and entrustable professional activities (EPAs). Most programs had a summative component, with APPE readiness being primarily assessed in the final didactic year of the pharmacy curriculum. Most programs report at least one source of validity. IMPLICATIONS: Given the lack of specific APPE readiness assessment requirements in the ACPE Standards 2016, the different assessment methods among programs were not surprising. However, the commonalities identified can be leveraged with the release of the Curricular Outcomes and Entrustable Professional Activities (COEPA) 2022 to promote a standardized definition of APPE readiness. Future research should focus on formative assessment methods embedded throughout the didactic curriculum to identify "at-risk" students prior to a "high-stakes" summative assessment at the end of the didactic curriculum that impedes student progression to the APPE year.

Adaptation and validation of the Children's Surgical Assessment Tool for Rwandan district hospitals.

BACKGROUND/AIMS: Paediatric surgical care is a critical component of child health and basic universal health coverage and therefore should be included in comprehensive evaluations of surgical capacity. This study adapted and validated the Children's Surgical Assessment Tool (CSAT), a tool developed for district and tertiary hospitals in Nigeria to evaluate hospital infrastructure, workforce, service delivery, financing, and training capacity for paediatric surgery, for use in district hospitals in Rwanda. METHODS: We used a three-round modified Delphi process to adapt the CSAT to the Rwandan context. An expert panel of surgeons, anaesthesiologists, paediatricians, and health systems strengthening experts were invited to participate based on their experience with paediatric surgical or anaesthetic care at district hospitals or with health systems strengthening in the Rwandan context. We used the Content Validity Index to validate the final tool. RESULTS: The adapted tool had a final score of 0.84 on the Content Validity Index, indicating a high level of agreement among the expert panel. The final tool comprised 171 items across five domains: facility characteristics, service delivery, workforce, financing, and training/research. CONCLUSION: The adapted CSAT is appropriate for use in district hospitals in Rwanda to evaluate the capacity for paediatric surgery. This study provides a framework for adapting and validating a comprehensive paediatric surgical assessment tool to local contexts in LMICs and used in similar settings in sub-Saharan Africa.

Assessment of the readiness and response toward the dengue fever outbreak (2019) in Sudan: a qualitative exploration.

BACKGROUND: Dengue fever (DF) is a mosquito-borne viral disease transmitted by Aedes mosquito species and has been considered a major public health problem in Kassala State for tens of years. This study aimed to assess the level of readiness and response toward the 2019 dengue fever outbreak in Kassala at the state and community levels. METHODS: This exploratory cross-sectional study was conducted in Kassala State, Sudan, from January to March 2020. The researcher conducted interviews with the key respondents at the state level to assess the level of readiness and response and to reflect the capacity of institutions-public health authorities, health systems, and emergency response bodies. RESULTS: The surveillance system reported 3961 DF cases in Kassala State, representing 93.5% of the total cases in Sudan between August 2019 and January 2020. This outbreak was identified by passive surveillance, 51 samples were tested during the outbreak period, and private clinics and labs were not included in the surveillance system. According to the WHO checklist of outbreak readiness and response, Kassala's surveillance system and public health laboratory received the lowest scores. CONCLUSIONS: The study concludes that outbreak readiness and response could be considered below standards, mainly in the surveillance system and laboratory diagnostic facilities, due to the absence of intersectoral collaboration with a regulatory framework in terms of financial and operational participation.

Pantry clients and Supplemental Nutrition Assistance Program-Education practitioners' perspectives on factors influencing healthy eating policy, system and environmental interventions in food pantries.

The Supplemental Nutrition Assistance Program-Education identified food pantries as a targeted setting for policy, system, and environmental (PSE) interventions to promote healthy eating among households who rely on pantries to supplement their food needs. The present study sought to identify factors influencing capacity and readiness to implement healthy eating PSE interventions in food pantries. Qualitative interviews were conducted via zoom with twenty-six community residents with experience receiving SNAP benefits and twelve SNAP-Ed staff in rural and urban counties in Ohio to identify themes and indicators related to community/organisational capacity and readiness to implement healthy eating PSE interventions in food pantries. Themes and related indicators generated based on inductive and deductive coding of interview transcripts were prioritised and weighted by eleven community nutrition experts during a virtual consensus conference. Five themes emerged; expert-derived weights (scaled low, 0 to high, 1) reflect the perceived importance of each to implementation of healthy eating PSE interventions in food pantries: food pantry capacity and logistics [0⋅252], networks and relationships [0⋅228], community nutrition practitioner capacity [0⋅212], food pantry user characteristics [0⋅156], and stigma and stereotypes [0⋅1⋅52]. Overall, seventeen indicators were identified reflecting these themes. Successful and sustained PSE interventions at food pantries will require a tailored approach that considers food pantries' capacity, needs and opportunities within the community, and capacity of community nutrition practitioners. The themes and indicators identified provide guidance for responsive PSE approaches in food pantries that meet communities where they are.

Contributions from incumbent police officer's physical activity and body composition to occupational assessment performance.

Introduction: Police officers must perform various tasks in unpredictable work environments and potentially volatile situations. This study aimed to determine if cardiovascular fitness, body composition, and physical activity levels could predict performance in a Midwest Police Department's Physical Readiness Assessment (PRA). Methods: Researchers collected data from thirty incumbent police officers (33.9 ± 8.3 years, female = 5). Anthropometric data included height, body mass, body fat percentage (BF%), fat-free mass (FFM), and maximal hand grip strength. The police officers also completed a physical activity rating (PA-R) scale to estimate maximal oxygen consumption (V˙O2max) and the International Physical Activity Questionnaire (IPAQ). Police officers then conducted their department's PRA. Stepwise linear regression analyses were used to determine the relationship between predictor variables and PRA performance. Pearson's product-moment correlations investigated relationships between anthropometric, physical fitness, and physical activity variables and PRA performance using SPSS (v.28). The significance level was set at p < 0.05. Results: Descriptive data for the sample includes BF%: 27.85 ± 7.57%, FFM: 65.73 ± 10.72 kg, hand grip strength: 55.51 ± 11.07 kg, weekday sedentary time (WST): 328 ± 28.26 min, weekend day sedentary time (WDST): 310 ± 28.92 min, daily moderate-to-vigorous physical activity (MVPA): 29.02 ± 39.41 min, PRA: 273.6 ± 51.4 s and estimated V˙O2max: 43.26 ± 6.35 mL kg-1 min-1. The stepwise regression analyses indicated that BF% was predictive of PRA time (R2 = 0.32, p < 0.01); estimated V˙O2max predictive of PRA time (R2 = 0.45, p < 0.001). There were significant correlations between BF % and PRA time (r = 0.57, p < 0.001), PA-R and MVPA (r = 0.71, p < 0.001), %BF % and WDST (r = -0.606, p < 0.001), hand grip and FFM (r = 0.602, p < 0.001) and PA-R and PRA time (r = -0.36, p < 0.05). Discussion: The results of this exploratory study highlight that higher estimated V˙O2max and lower BF% were the best predictors for faster PRA completion times, accounting for 45% and 32% of the variance, respectively. The findings of this study support the need for wellness and fitness initiatives in law enforcement agencies focused on increasing cardiovascular fitness and physical activity while decreasing BF% to ensure optimal performance in policing and overall health.

Assessing the Readiness to Provide Integrated Management of Cardiovascular Diseases and Type 2 Diabetes in Kenya: Results from a National Survey.

Introduction: Integrated chronic disease management is the desired core function of a responsive healthcare system. However, many challenges surround its implementation in Sub-Saharan Africa. The current study assessed the readiness of healthcare facilities to provide integrated management of cardiovascular diseases (CVDs) and type 2 diabetes in Kenya. Methods: We used data from a nationally representative cross-sectional survey of 258 public and private health facilities conducted in Kenya between 2019 and 2020. Data were collected using a standardised facility assessment questionnaire and observation checklists modified from the World Health Organization Package of Essential Non-communicable Diseases. The primary outcome was the readiness to provide integrated care for CVDs and diabetes-defined as the mean availability of tracer items comprising trained staff and clinical guidelines, diagnostic equipment, essential medicines, diagnosis, treatment and follow-up. A cut-off threshold of ≥70% was used to classify facilities as 'ready'. Gardner-Altman plots and modified Poisson regression were used to examine the facility characteristics associated with care integration readiness. Results: Of the surveyed facilities, only a quarter (24.1%) were ready to provide integrated care for CVDs and type 2 diabetes. Care integration readiness was lower in public versus private facilities [aPR = 0.6; 95% CI 0.4 to 0.9], and primary healthcare facilities were less likely to be ready compared to hospitals [aPR = 0.2; 95% CI 0.1 to 0.4]. Facilities located in Central Kenya [aPR = 0.3; 95% CI 0.1 to 0.9], and the Rift Valley region [aPR = 0.4; 95% CI 0.1 to 0.9], were less likely to be ready compared to the capital Nairobi. Conclusions: There are gaps in the readiness of healthcare facilities particularly primary healthcare facilities in Kenya to provide integrated care services for CVDs and diabetes. Our findings inform the review of current supply-side interventions for integrated management of CVDs and type 2 diabetes, especially in lower-level public health facilities in Kenya.

A Patient Portal Intervention to Promote Adolescent and Young Adult Self-Management Skills.

OBJECTIVE: Failure to transfer care to adult medicine is associated with gaps in health care access and poor health outcomes among young adults. We examined whether a patient portal educational intervention is acceptable and can improve adolescent and young adult (AYA) self-management skills toward transition readiness to adult care. METHODS: We conducted a single site feasibility study using a mixed research method consisting of 1) a patient portal one-on-one educational intervention with pre- and postsurveys adapted from the Transition Readiness Assessment Questionnaire to assess participant self-management skills and portal user activity; 2) portal user experience was assessed through semistructured interviews until thematic saturation was reached. Study participants were 13 to 25 years old and received care at an academic-affiliated community pediatric clinic. Descriptive statistics were used to describe participant characteristics, paired t tests, or Wilcoxon signed-rank tests to assess outcomes of survey response changes pre- versus postintervention. RESULTS: Sixty percent of enrolled participants (N = 78) completed the surveys. Following the educational intervention, we observed an increase in participants self-reporting knowing how to access their protected health information P < .0001, (95%, confidence interval [CI], 1-2) and in the proportion of participants self-reporting to strongly agree to know their medication P = .025 (95%, CI 0-1). We also observed an increase in portal user access at 3 weeks; the median number of logins was 2 per participant (range 1-36, P < .0001). The Portal user experience was strongly positive. CONCLUSION: Our patient portal educational intervention suggests that AYAs welcome a patient portal to access protected health information and is associated with an increase in the proportion of participants self-reporting to strongly agree with knowing their medication. While these results are encouraging, this is a quasiexperimental study designed on the frame of feasibility. Our study was not adequately powered, limiting our findings' significance. Future interventions would benefit from a larger sample size with a comparison group to ascertain the effect of a patient portal on self-management skills in a diverse AYA population and inform best practices.

System and facility readiness assessment for conducting active surveillance of adverse events following immunization in Addis Ababa, Ethiopia.

BACKGROUND: To help distinguish vaccine-related adverse events following immunization (AEFI) from coincidental occurrences, active vaccine pharmacovigilance (VP) prospective surveillance programs are needed. From February to May 2021, we assessed the system and facility readiness for implementing active AEFI VP surveillance in Addis Ababa, Ethiopia. METHODS: Selected hospitals were assessed using a readiness assessment tool with scoring measures. The site assessment was conducted via in-person interviews within the specific departments in each hospital. We evaluated the system readiness with a desk review of AEFI guidelines, Expanded Program for Immunization Guidelines and Ethiopian Food and Drug Administration and Ethiopian Public Health Institute websites. RESULTS: Of the hospitals in Addis Ababa, 23.1% met the criteria for our site assessment. During the system readiness assessment, we found that essential components were in place. However, rules, regulations and proclamations pertaining to AEFI surveillance were absent. Based on the tool, the three hospitals (A, B and C) scored 60.6% (94/155), 48.3% (75/155) and 40% (62/155), respectively. CONCLUSIONS: Only one of three hospitals assessed in our evaluation scored >50% for readiness to implement active AEFI surveillance. We also identified the following areas for improvement to ensure successful implementation: training, making guidelines and reporting forms available and ensuring a system that accommodates paper-based and electronic-based recording systems.

Using the lens of assistive technology to develop a technology translation readiness assessment tool (TTRAT)™ to evaluate market readiness.

PURPOSE: Assistive Technologies encompass a wide array of products, services, healthcare standards, and the systems that support them. Product/market fit is necessary for a technology to be transferred successfully. Current tools lack variables that are key to technology transfer, and current trainings do not have a validated tool to assess the effectiveness of a training, increasing innovators' readiness for technology transfer. The goal was to develop a tool to evaluate the readiness of a technology by incorporating other models and focusing beyond just commercialization. MATERIALS AND METHODS: The development involved five stages: 1. Review of current tools used in technology transfer in academic, government, and industry settings; 2. Development of the draft version of the tool with internal review; 3. Alpha version review and refinement, 4. Content validation of the tool's beta version; 5. Assessment of the readiness tool for reliability and preparedness for wide-use dissemination. RESULTS: The tool was revised and validated to 6 subscales and 25 items. The assistive technology subscale was removed from the final version to eliminate repetitive questions and taking into consideration that the tool could be used across technologies. CONCLUSIONS: We developed a flexible assessment tool that looked beyond just commercial success and considered the problem being solved, implications on or input from stakeholders, and sustainability of a technology. The resulting product, the Technology Translation Readiness Assessment Tool (TTRAT)TM, has the potential to be used to evaluate a broad range of technologies and assess the success of training programs.IMPLICATIONS FOR REHABILIATIONQuality of life can be substantially impacted when an assistive technology does not meet the needs of an end-user. Thus, effective Assistive Technology Tech Transfer (ATTT) is needed.The use of the TTRAT may help to inform NIDILRR and other funding agencies that invest in rehabilitation technology development on the overall readiness of a technology, but also the impact of the funding on technology readiness.The TTRAT may help to educate novice rehabilitation technology innovators on appropriate considerations for not only technology readiness, but also general translation best practices like assembling a diverse team with appropriate skillsets, understanding of the market and its size, and sustainability strategies.

Formative Exploration of the Feasibility of Embedding Community Assets Into Primary Health Care: Barbershop and Place of Worship Readiness in Guyana.

INTRODUCTION: Community engagement is key to improving the quality of primary health care (PHC), with asset-based interventions shown to have a positive impact on equity and health outcomes. However, there tends to be a disconnect between community-based interventions and PHC, with a lack of evidence on how to develop sustainable community-primary care partnerships. This paper reports on the formative phases of 2 studies exploring the feasibility of embedding community assets, namely places of worship and barbershops, into the PHC pathway for the prevention and control of NCDs in deprived settings. It describes the participatory approach used to map and gather contextual readiness information, including the enablers and constrainers for collaborative partnerships with PHC. METHODS: Grounded in community-based participatory research, we used elements of ground-truthing and participatory mapping to locate and gather contextual information on places of worship and barbershops in urban and rural communities. Local knowledge, gathered from community dialogs, led to the creation of sampling frames of these community assets. Selected places of worship were administered a 66-item readiness questionnaire, which included domains on governance and financing, congregation profile, and existing health programs and collaborations. Participating barbershops were administered a 40-item readiness questionnaire, which covered barbers' demographic information, previous training in health promotion, and barbers' willingness to deliver health promotion activities. RESULTS: Fourteen barbershops were identified, of which 10 participated in the readiness survey, while 240 places of worship were identified, of which 14 were selected and assessed for readiness. Contextual differences were found within and between these assets regarding governance, accessibility, and reach. Key enablers for both include training in health promotion, an overwhelming enthusiasm for participation and recognition of the potential benefits of a community-primary care partnership. Lack of previous collaborations with the formal health system was common to both. CONCLUSION: The participatory approach extended reach within underserved communities, while the readiness data informed intervention design and identified opportunities for partnership development. Contextual differences between community assets require comprehensive readiness investigations to develop suitably tailored interventions that promote reach, acceptance, and sustainability.

Transition readiness assessment in adolescents and young adults with rheumatic diseases: The Singapore experience.

BACKGROUND: Transition from pediatric to adult care is a challenging time for adolescents and young adults (AYA) with rheumatic diseases. Validated tools have been developed to assess transition readiness. AIM: To evaluate transition readiness among AYA with rheumatic diseases and to identify factors associated with transition readiness. METHODS: Patients ≥15 years old were enrolled into our transition program and administered a Transition Readiness Assessment Tool (TRAT) from July 2017. The TRAT consists of 3 components: (a) patient's perception on importance of transition and confidence toward transition on a Likert scale 0-10; (b) assessment of knowledge on medical and healthcare usage using a set of 23 questions; (c) transition readiness using the Transition Readiness Assessment Questionnaire (TRAQ). Differences between groups were compared to identify factors associated with transition readiness. RESULTS: Transition readiness assessment was performed in 152 patients. The median score for perception on transition importance was 7.0 (5.0-8.8) and the median score for confidence in transition was 7.0 (5.0-9.0). Majority of the patients (>50%) lack knowledge in health insurance, carrying health information, healthcare privacy changes and making own healthcare decision. Patients <20 years old were also deficient in knowledge in navigating healthcare systems. TRAQ scores were lowest in areas pertaining to healthcare insurance and obtaining financial help. CONCLUSION: Healthcare insurance literacy and self-management skills were lacking in the assessment of transition readiness in AYA with rheumatic diseases. Targeted intervention in these areas will improve transition readiness and promote successful transition processes.

Facilitators and Challenges to Health Promotion in Black and Latino Churches.

BACKGROUND: Churches are important assets for the African American and Latino communities. They can play a critical role in health promotion, especially in areas that are under-resourced and in which residents have limited access to health care. A better understanding of health promotion in churches is needed to support and maintain church collaborations and health initiatives that are integrated, data-driven, and culturally appropriate. The purpose of this study is to identify churches' facilitators and challenges to health promotion and to contrast and compare Black and Latino churches of different sizes (< 200 members versus > 200 members). METHODS: We interviewed leaders of 100 Black and 42 Latino churches in South Los Angeles to assess their history of wellness activities, resources, facilitators, and challenges to conduct health promotion activities. RESULTS: Eighty-three percent of African American and 86% of Latino church leaders reported at least one health activity in the last 12 months. Black and Latino churches of different sizes have similar interests in implementing specific health promotion strategies and face similar challenges. However, we found significant differences in the composition of their congregations, number of paid staff, and the proportions of churches that have a health or wellness ministry and that implement specific wellness strategies. Fifty-seven percent of African American and 43% of Latino church leaders stated that they needed both financial support and professional expertise for health promotion. DISCUSSION: Our findings highlight the importance of conducting a readiness assessment for identifying intervention content and strategies that fit the intervention context of a church.

The Transition to an Entirely Digital Immunization Registry in Ha Noi Province and Son La Province, Vietnam: Readiness Assessment Study.

BACKGROUND: Vietnam is one of the first low- to middle-income countries to develop and implement a national-scale electronic immunization registry. This system was finalized into the National Immunization Information System (NIIS) and scaled up to a national-level system in 2017. As a result, immunization coverage and the timeliness of vaccinations have drastically improved. The time spent on planning and reporting vaccinations has drastically reduced; as a result, vaccination planning and reporting has become more accurate and effective. However, to date, end users have been tasked with managing both the NIIS and paper-based systems in parallel until a formal assessment of the readiness to fully transition to the NIIS is conducted. OBJECTIVE: This study aims to evaluate the readiness to move to an entirely digital NIIS in 2 provinces of Vietnam-Ha Noi and Son La. METHODS: All health facilities were surveyed to assess their infrastructure, capacity, and need for human resources. NIIS end users were observed and interviewed to evaluate their NIIS knowledge and skill sets. Data from immunization cards and facility paper-based logbooks were compared with data from the NIIS, and vaccine stocks at selected facilities were tallied and compared with data from the NIIS. RESULTS: Of the 990 health facilities evaluated, most used the NIIS to enter and track immunizations (987/990, 99.7%) and vaccine stocks (889/990, 90.8%). Most had stable electricity (971/990, 98.1%), at least 1 computer (986/990, 99.6%), and ≥2 trained NIIS end users (825/990, 83.3%). End users reported that the NIIS supported them in managing and reporting immunization data and saving them time (725/767, 94.5%). Although many end users were able to perform basic skills, almost half struggled with performing more complex tasks. Immunization data were compiled from the NIIS and immunization cards (338/378, 89.4%) and paper-based logbooks (254/269, 94.4%). However, only 54.5% (206/378) of immunization IDs matched, 57% (13/23) of Bacillus Calmette-Guérin vaccination records were accurate, and 70% (21/30) of the facilities had consistent physical vaccine stock balances. The feedback received from NIIS end users suggests that more supportive supervision, frequent refresher training for strengthening their skill sets, and detailed standardized guides for improving data quality are needed. CONCLUSIONS: The readiness to transition to a digital system is promising; however, additional resources are required to address the timeliness, completeness, and accuracy of the data.

Assessing service availability and readiness to manage cervical cancer in Bangladesh.

BACKGROUND: The second most common cancer among females in Bangladesh is cervical cancer. The national strategy for cervical cancer needs monitoring to ensure that patients have access to care. In order to provide accurate information to policymakers in Bangladesh and other low and middle income countries, it is vital to assess current service availability and readiness to manage cervical cancer at health facilities in Bangladesh. METHODS: An interviewer-administered questionnaire adapted from the World Health Organization Service Availability and Readiness Assessment Standard Tool was used to collect cross-sectional data from health administrators of 323 health facilities in Bangladesh. Services provided were categorized into domains and service readiness was determined by mean readiness index (RI) scores. Data analysis was conducted using STATA version 13. RESULTS: There were seven tertiary and specialized hospitals, 118 secondary level health facilities, 124 primary level health facilities, and 74 NGO/private hospitals included in the study. Twenty-six per cent of the health facilities provided services to cancer patients. Among the 34 tracer items used to assess cancer management capacity of health facilities, four cervical cancer-specific tracer items were used to determine service readiness for cervical cancer. On average, tertiary and specialized hospitals surpassed the readiness index cutoff of 70% with adequate staff and training (100%), equipment (100%), and diagnostic facilities (85.7%), indicating that they were ready to manage cervical cancer. The mean RI scores for the rest of the health facilities were below the cutoff value, meaning that they were not prepared to provide adequate cervical cancer services. CONCLUSION: The health facilities in Bangladesh (except for some tertiary hospitals) lack readiness in cervical cancer management in terms of guidelines on diagnosis and treatment, training of staff, and shortage of equipment. Given that cervical cancer accounts for more than one-fourth of all female cancers in Bangladesh, management of cervical cancer needs to be available at all levels of health facilities, with primary level facilities focusing on early diagnosis. It is recommended that appropriate standard operating procedures on cervical cancer be developed for each level of health facilities to contribute towards attaining sustainable developmental goals.

A Cross-Sectional Community Readiness Assessment for Implementing School-Based Comprehensive Sexuality Education in Islamabad, Pakistan.

Evidence indicates that school-based sexuality education empowers children and adolescents with the skills, values, and attitudes that will enable them to appreciate their health and well-being, nourish respectful social and sexual relationships, understand their rights, and to make informed choices. Owing to organized community resistance and prevalent misconceptions, promoting sexual and reproductive health has been challenging, especially in conservative settings like Pakistan. This study aimed at systematically exploring communities' perceptions regarding implementing school-based comprehensive sexuality education by conducting a cross-sectional community readiness assessment in Islamabad, Pakistan. A total of 35 semi-structured interviews were conducted with community key informants. Following the guidelines of the community readiness handbook, the interviews were transcribed and scored by two independent raters. The results indicate that, overall, the Islamabad community is at stage two of community readiness, the denial/resistance stage. Individual dimension scores indicate that knowledge of efforts, resources for efforts, knowledge about the issue, and leadership dimensions are at the denial/resistance stage. Only community climate was rated at stage three of community readiness, the vague awareness stage. This indicates that, for promoting sexuality education in the Pakistani context, it is essential to tackle resistance by sensitizing the community and the stakeholders through awareness campaigns.

Development of an evidence-based e-health readiness assessment framework for Uganda.

BACKGROUND: While e-health readiness assessment is vital to the successful implementation of e-health innovations, there is little published guidance (i.e. e-health readiness assessment frameworks (eHRAFs)) for institutions and countries. OBJECTIVE: To develop an evidence-based and locally relevant eHRAF for Uganda. METHOD: A list of possible e-health readiness domains and constructs was developed through a structured review of the e-health literature. This list was first refined using author experience, insight and reflection. Based on this refined list, an eHRAF questionnaire was developed, which was initially pilot tested for face and content validity. Thereafter, it was distributed to 13 purposively selected study participants who were Ugandan e-health experts from the fields of health, information and communications technology (ICT) and academia. The questionnaire was discussed in a focus group setting for consensus input, where study participants confirmed, rejected or revised proposed domains and constructs suitable to guide e-health readiness assessment at either the national or site-specific level within Uganda. RESULTS: Of 148 identified literature resources, 13 met inclusion criteria. A subjective review highlighted 11 frequently used e-health domains. Further reflection reduced these to nine domains, which were shared with study participants by means of the questionnaire. Based upon prior use of, and familiarity with, a management tool (PESTEL), participants' consensus on factors essential for readiness assessment in Uganda was aligned with PESTEL's six domains: political, economic, sociocultural, technological, environmental, and legal and regulatory. The participants considered engagement, and core and societal readiness as optional domains. Based on this input, the authors developed a proposed eHRAF suitable for Uganda, comprised of domains, sub-domains and constructs. CONCLUSION: The eHRAF developed in this research is an evidence-based framework (literature and cross-sectoral expert opinion) and consists of primary domains, sub-domains and constructs suitable for assessing e-health readiness in Uganda, either nationally or locally, prior to implementation of any e-health system. The process and principles may have utility in other countries. IMPLICATIONS: A national, culturally relevant, context-specific Ugandan eHRAF could facilitate efficient and effective planning and implementation of new e-health programmes across the country and assist policymakers and legislators to develop consistent and reliable guidelines and regulations.

Validation of an e-health readiness assessment framework for developing countries.

BACKGROUND: Studies document e-health as having potential to improve quality of healthcare services, resulting in both developed and developing countries demonstrating continued interest in e-health uptake and use. e-Health implementations are not always successful as high failure rates have been reported in both developed and developing countries. These failures are often a result of lack of e-health readiness. e-Health readiness has been defined as the preparedness of healthcare institutions or communities for the anticipated change brought by programs related to information and communication technologies. As such it is critical to conduct an e-health readiness assessment prior to implementation of e-health innovations so as to reduce chances of project failure. Noting the absence of an adequate e-health readiness assessment framework (eHRAF) suitable for use in developing countries, the authors conceptualised, designed, and created a developing country specific eHRAF to aid in e-health policy planning. The aim of this study was to validate the developed eHRAF and to determine if it required further refinement before empirical testing. METHODS: Published options for a framework validation process were adopted, and fifteen globally located e-health experts engaged. Botswana experts were engaged using saturation sampling, while international experts were purposively selected. Responses were collated in an Excel spreadsheet, and NVivo 11 software used to aid thematic analysis of the open ended questions. RESULTS: Analysis of responses showed overall support for the content and format of the proposed eHRAF. Equivocal responses to some open ended questions were recorded, most of which suggested modifications to terms within the framework. One expert from the developed world had alternate views. CONCLUSIONS: The proposed eHRAF provides guidance for e-health policy development and planning by identifying, in an evidence based manner, the major areas to be considered when preparing for an e-health readiness assessment in the context of developing countries.

Organizational readiness for wellness promotion - a survey of 100 African American church leaders in South Los Angeles.

BACKGROUND: Churches are an important asset and a trusted resource in the African American community. We needed a better understanding of their readiness to engage in health promotion before launching a large-scale health promotion effort in partnership with South Los Angeles churches. METHODS: In 2017, we conducted surveys with leaders of 100 churches. Surveys were conducted face-to-face (32%) or by telephone (68%) with senior pastors (one per church) and lasted on average 48 min. We compared small (less than 50 active members), medium (50-99 active members) and large churches (at least 100 active members), and assessed which church characteristics were associated with the implementation of wellness activities. RESULTS: Medium and large churches conducted significantly more wellness activities than small churches and were more likely to have wellness champions and health policies. Regardless of church size, insufficient budget was the most commonly cited barrier to implement wellness activities (85%). A substantial proportion of churches was not sure how to implement wellness activities (61%) and lacked volunteers (58%). Forty-five percent of the variation in the number of wellness activities in the last 12 months was explained by church characteristics, such as size of congregation, number of paid staff, leadership engagement, having a wellness ministry and barriers. CONCLUSIONS: Many churches in South Los Angeles are actively engaged in health promotion activities, despite a general lack of resources. We recommend a comprehensive assessment of church characteristics in intervention studies to enable the use of strategies (e.g., stratification by size) that reduce imbalances that could mask or magnify study outcomes. Our data provide empirical support for the inner settings construct of the Consolidated Framework for Implementation Research in the context of health promotion in African American churches.

Medical Encounters During the United States Army Special Forces Assessment and Selection Course.

INTRODUCTION: The Special Forces Assessment and Selection (SFAS) is an extremely physically and mentally demanding 19- to 20-day course designed to determine whether Soldiers are qualified to enter the Special Forces Qualification Course. As a first step to understand medical problems during SFAS, this study examined injuries, illnesses, and activities associated with injuries during the course. MATERIALS AND METHODS: Medical events during the SFAS course were compiled from Sick Call Trackers (a log of medical encounters maintained by medical personnel in the field) and Chronology of Medical Care (Standard Form 600). Descriptive statistics were calculated for each injury and illness and injuries were compiled by the activities performed when the injuries occurred. RESULTS: Of the 800 Soldiers who volunteered for the study, 38% (n = 307/800) and 12% (n = 97/800) experienced one or more injuries and/or illnesses, respectively. The most common injuries were blisters and abrasions/lacerations with incidences of 20% (n = 158/800) and 13% (104/800), respectively. The most common illnesses were respiratory infections, other infections, contact dermatitis, and allergies with incidences of 7% (n = 57/800), 2% (n = 14/800), 2% (n = 14/800), and 2% (n = 13/800), respectively. Among all injuries recorded (n = 573), the most common were blisters (46%), abrasions/lacerations (24%), pain (not otherwise specified) (19%), tendonitis (3%), and sprains (3%). Among all illnesses recorded (n = 133), the most common were respiratory infections (56%), allergies (11%), contact dermatitis (11%), and other infections (11%). Most injuries were experienced during land navigation (44%), team events (20%), and foot marching (11%), running (6%), and the obstacle course (5%), but when the estimated time involved for each event was considered, activities with the highest injury rates were the obstacle course (65 injuries/hr), running (27 injuries/hr), the Combat Readiness Assessment (activity involving combat-related tasks) (20 injuries/hr), and foot marching (16 injuries/hr). CONCLUSION: The major limitations of this investigation were: 1) the low specificity with regard to many of the diagnoses/complaints; and 2) the fact that the medical problems reported here are only those seen by medical care providers and are likely an underestimate of the total morbidity in the SFAS course. Soldiers often self-treat and some may be reluctant to see medical personnel because of how it might affect their rating in the course. Nonetheless, this investigation alerts medical personnel to the injuries and illnesses to expect, and public health workers and leadership with activities to target for injury prevention measures during SFAS.

A Dene First Nation's community readiness assessment to take action against HIV/AIDS: a pilot project.

BACKGROUND: Among Indigenous people in Canada the incidence of HIV is 3.5 times higher than other ethnicities. In Manitoba First Nations, Metis and Inuit people are disproportionately represented (40%) among people who are new to HIV care. Northlands Denesuline First Nation (NDFN) identified the need to revisit their level of knowledge and preparedness for responding to the increasing rates of HIV. NDFN piloted a community readiness assessment (CRA) tool to assess its appropriateness for use in northern Manitoba. METHODS: A First Nation and non-First Nation research team trained to administer the CRA tool at NDFN in Manitoba. Five informants were interviewed using the CRA tool and the responses were scored, analysed and reviewed at community workshops and with stakeholders to develop a 1-year action plan. RESULTS: CRA training was best conducted in the community. Using the readiness score of 2.4 along with feedback from two workshops, community members, the research team and stakeholders, we identified priorities for adult education and youth involvement in programmes and planning. CONCLUSIONS: In response to the increasing incidence of HIV, a northern First Nation community successfully modified and implemented a CRA tool to develop an action plan for culturally appropriate interventions and programmes.