Diverse Recruitment Strategies Are Needed to Reduce Digital Divide: Results from a Workshop Addressing Digital Divide and Effects of Pandemic Restrictions.

Recruitment is a bottleneck for research - especially digital health studies. Studies often focus on those who are easy to reach or already engaged in their health, leaving those who are uninterested or un-engaged, as "un-reached". This contributes to the "digital divide". COVID-19 restrictions made recruitment more difficult. During a virtual workshop of our peers, we discussed recruitment of un-reached groups for digital health studies, especially during COVID-times. All agreed; we need to go where the un-reached are by collaborating with community-based services and organizations.

Recognizing Cross-Institutional Fiscal and Administrative Barriers and Facilitators to Conducting Community-Engaged Clinical and Translational Research.

PURPOSE: This qualitative study examined fiscal and administrative (i.e., pre- and post-award grants process) barriers and facilitators to community-engaged research among stakeholders across 4 Clinical and Translational Science Awards (CTSA) institutions. METHOD: A purposive sample of 24 key informants from 3 stakeholder groups-community partners, academic researchers, and research administrators-from the CTSA institutions at the University of North Carolina at Chapel Hill, Medical University of South Carolina, Vanderbilt University Medical Center, and Yale University participated. Semistructured interviews were conducted in March-July 2018, including questions about perceived challenges and best practices in fiscal and administrative processes in community-engaged research. Transcribed interviews were independently reviewed and analyzed using the Rapid Assessment Process to facilitate key theme and quote identification. RESULTS: Community partners were predominantly Black, academic researchers and research administrators were predominantly White, and women made up two-thirds of the overall sample. Five key themes were identified: level of partnership equity, partnership collaboration and communication, institutional policies and procedures, level of familiarity with varying fiscal and administrative processes, and financial management expectations. No stakeholders reported best practices for the institutional policies and procedures theme. Cross-cutting challenges included communication gaps between stakeholder groups; lack of or limits in supporting community partners' fiscal capacity; and lack of collective awareness of each stakeholder group's processes, procedures, and needs. Cross-cutting best practices centered on shared decision making and early and timely communication between all stakeholder groups in both pre- and post-award processes. CONCLUSIONS: Findings highlight the importance of equitable processes, triangulated communication, transparency, and recognizing and respecting different financial management cultures within community-engaged research. This work can be a springboard used by CTSA institutions to build on available resources that facilitate co-learning and discussions between community partners, academic researchers, and research administrators on fiscal readiness and administrative processes for improved community-engaged research partnerships.

Knowledge Toward Cervical Cancer and Its Determinants Among Women Aged 30-49 in Jimma Town, Southwest Ethiopia.

BACKGROUND: Cervical cancer is one of the common causes of premature death and disability in women worldwide. It is preventable through vaccination, and screening for precancerous lesions and early treatment. However, screening service uptake and treatment for cervical cancer face significant challenges in low-income countries due to poor information systems. The aim of this study was to assess knowledge of cervical cancer and its determinants among women aged 30-49 years living in Jimma Town, Southwest Ethiopia. METHODS: A community-based cross-sectional study was undertaken from March 20 to April 15, 2017. The data were collected using a structured interviewer-administered questionnaire and analyzed by SPSS version 21. Multivariable logistic regression anaysis was done and variables with a p-value < 0.05 were considered statistically significant. RESULTS: Of the interviewed women, only 321(43.6%) had adequate knowledge about cervical cancer and screening. Attending secondary school or above (AOR = 2.42, 95% CI: 1.24-4.74), using modern contraceptives (AOR = 6.31, 95% CI: 2.86-13.89), knowing somebody with cervical cancer (AOR = 2.24, 95% CI: 1.35-3.71) and knowing someone screened for cervical cancer (AOR = 2.23, 95% CI: 1.30-3.80) were associated with knowledge of cervical cancer. CONCLUSION: Knowledge of cervical cancer is low in the current study area even if appropriate knowledge regarding the disease is important in decreasing the incidence and prevalence of cervical cancer through screening and human pappiloma virus vaccination. Increasing awereness regarding the disease and prevention strategies are the key issue.

Power, participation and their problems: A consideration of power dynamics in the use of participatory epidemiology for one health and zoonoses research.

The use of Participatory Epidemiology in veterinary research intends to include livestock keepers and other local stakeholders in research processes and the development of solutions to animal health problems, including potentially zoonotic diseases. It can also be an attempt to bring some of the methods and insights of social science into a discipline largely shaped by natural science methods and ways of seeing the world. The introduction of participatory methodologies to veterinary epidemiology and disease surveillance follows a wider movement in development thinking, questioning the top-down nature of much post-second world war development efforts directed from the Global North towards the Global South. In the best cases, participatory methods can help to empower the poor and marginalised to participate in and have some control over research and interventions which affect them. Compiled from experience in multi-disciplinary One Health projects, this paper briefly traces the rise of participatory epidemiology before examining some of the limitations observed in its implementation and steps that might be taken to alleviate the problems observed. The three areas in which the operationalisation of Participatory Epidemiology in veterinary and One Health research could be improved are identified as: broadening the focus of engagement with communities beyond quantitative data extraction; taking note of the wider power structures in which research takes place, and questioning who speaks for a community when participatory methods are used. In particular, the focus falls on how researchers from different disciplines, including veterinary medicine and the social sciences, can work together to ensure that participatory epidemiology is employed in such a way that it improves the quality of life of both people and animals around the world.

Factors associated with biomedical research participation within community-based samples across 3 National Cancer Institute-designated cancer centers.

BACKGROUND: Engaging diverse populations in biomedical research, including biospecimen donation, remains a national challenge. This study examined factors associated with an invitation to participate in biomedical research, intent to participate in biomedical research in the future, and participation in biomedical research and biospecimen donation among a diverse, multilingual, community-based sample across 3 distinct geographic areas. METHODS: Three National Cancer Institute-designated cancer centers engaged in community partnerships to develop and implement population health assessments, reaching a convenience sample of 4343 participants spanning their respective catchment areas. Data harmonization, multiple imputation, and multivariable logistic modeling were used. RESULTS: African Americans, Hispanic/Latinos, and other racial minority groups were more likely to be offered opportunities to participate in biomedical research compared to whites. Access to care, history of cancer, educational level, survey language, nativity, and rural residence also influenced opportunity, intent, and actual participation in biomedical research. CONCLUSIONS: Traditionally underserved racial and ethnic groups reported heightened opportunity and interest in participating in biomedical research. Well-established community partnerships and long-standing community engagement around biomedical research led to a diverse sample being reached at each site and may in part explain the current study findings. However, this study illustrates an ongoing need to establish trust and diversify biomedical research participation through innovative and tailored approaches. National Cancer Institute-designated cancer centers have the potential to increase opportunities for diverse participation in biomedical research through community partnerships and engagement. Additional work remains to identify and address system-level and individual-level barriers to participation in both clinical trials and biospecimen donation for research.

The association between sleep efficiency and diabetes mellitus in community-dwelling individuals with or without sleep-disordered breathing.

BACKGROUND: Sleeping habits have been reported to be associated with diabetes mellitus. This study aimed to explore the relationship of sleep efficiency with diabetes mellitus in individuals with or without sleep-disordered breathing based on polysomnography records. METHODS: We enrolled participants from the Sleep Heart Health Study. Objective indicators of sleep characteristics including sleep efficiency, sleep latency, slow-wave sleep, wake after sleep onset, and total arousal index were monitored via in-home polysomnography. Sleep efficiency was divided into grade 1 (≥85%), grade 2 (80%-84.9%), and grade 3 (<80%). Multivariate logistic regression models were utilized to investigate the association between sleep quality and diabetes mellitus. RESULTS: The present study comprised 4737 participants with a mean age of 63.6 ± 11.0 years. The prevalence of diabetes mellitus was higher in those with grade 3 sleep efficiency than that in those with grade 1 and grade 2 sleep efficiency in participants with (10.9% vs 8.5% vs 8.3%, respectively; P =.134) or without (9.5% vs 5.6% vs 3.5%, respectively; P <.001) sleep-disordered breathing. After adjusting for potential confounding factors, sleep efficiency <80% was associated with the prevalence of diabetes mellitus only in participants without sleep-disordered breathing (odds ratio, 1.894; 95% confidence interval, 1.187-3.022, P =.007). CONCLUSION: Poor sleep efficiency is associated with diabetes mellitus in those without sleep-disordered breathing. Therefore, the relationship between sleep efficiency and diabetes mellitus is worth further investigation.

New impulses from international development for more comprehensive and balanced public engagement evaluation.

Public engagement in health research has gained popularity because of its potential to co-create knowledge, generate dialogue, and ground research in the priorities and realities of the target groups. However, public engagement that achieves these objectives could still entail unforeseen negative consequences or a wasteful use of resources. Although the evaluation of public engagement has evolved in recent years, we lack consistent evaluation criteria for systematic and transparent assessments of success and failure. This article introduces standard evaluation criteria from the field of development aid evaluation (effectiveness, efficiency, impact, relevance, sustainability) to promote more systematic and comprehensive evaluation practice. I apply these criteria to the public engagement component of a recent research project into antimicrobial resistance, antibiotic use, and health behaviour in Thailand and Laos. Considering village-level engagement workshops, international exhibitions of photo narratives of traditional healing in northern Thailand, and social media communication, I demonstrate that activities that seem to achieve their objectives can still have problematic characteristics in other dimensions. I conclude that these five generic evaluation criteria can broaden our understanding of public engagement. Their more widespread use in evaluations can help build a more comprehensive and balanced evidence base, even if only a sample of public engagement projects and programmes can be evaluated systematically.

Bi-Directional Learning: Identifying Contaminants on the Yurok Indian Reservation.

The Yurok Tribe partnered with the University of California Davis (UC Davis) Superfund Research Program to identify and address contaminants in the Klamath watershed that may be impairing human and ecosystem health. We draw on a community-based participatory research approach that begins with community concerns, includes shared duties across the research process, and collaborative interpretation of results. A primary challenge facing University and Tribal researchers on this project is the complexity of the relationship(s) between the identity and concentrations of contaminants and the diversity of illnesses plaguing community members. The framework of bi-directional learning includes Yurok-led river sampling, Yurok traditional ecological knowledge, University lab analysis, and collaborative interpretation of results. Yurok staff and community members share their unique exposure pathways, their knowledge of the landscape, their past scientific studies, and the history of landscape management, and University researchers use both specific and broad scope chemical screening techniques to attempt to identify contaminants and their sources. Both university and tribal knowledge are crucial to understanding the relationship between human and environmental health. This paper examines University and Tribal researchers' shared learning, progress, and challenges at the end of the second year of a five-year Superfund Research Program (SRP) grant to identify and remediate toxins in the lower Klamath River watershed. Our water quality research is framed within a larger question of how to best build university-Tribal collaboration to address contamination and associated human health impacts.

Improving Physical Activity and Outdoor Recreation in Rural Alabama Through Community Coalitions.

Obesity rates in the United States are trending upward, and disadvantaged populations continue to have disproportionate rates of obesity. In Alabama, the ALProHealth initiative used community-based participatory research to work with community coalitions to implement research-based interventions that addressed issues related to the lack of opportunities for physical activity in 14 counties whose populations are at high risk of obesity. Coalitions developed work plans and timelines for implementing interventions on the basis of issues discussed during focus groups at the beginning of the ALProHealth initiative. These 14 coalitions implemented 101 interventions related to physical activity in 16 communities. In this evaluation, we measured potential reach and improvements in amenities. The largest reach for an intervention was achieved through marketing and communication efforts, while the most popular intervention, undertaken by the largest number of communities, centered on installing or repairing playground equipment at community parks. Community-based participatory research is an effective method for addressing health issues at the local level, as interventions are developed and readily adopted through active partnerships with community leaders and residents.

Hiring, training, and supporting Peer Research Associates: Operationalizing community-based research principles within epidemiological studies by, with, and for women living with HIV.

BACKGROUND: A community-based research (CBR) approach is critical to redressing the exclusion of women-particularly, traditionally marginalized women including those who use substances-from HIV research participation and benefit. However, few studies have articulated their process of involving and engaging peers, particularly within large-scale cohort studies of women living with HIV where gender, cultural and linguistic diversity, HIV stigma, substance use experience, and power inequities must be navigated. METHODS: Through our work on the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS), Canada's largest community-collaborative longitudinal cohort of women living with HIV (n = 1422), we developed a comprehensive, regionally tailored approach for hiring, training, and supporting women living with HIV as Peer Research Associates (PRAs). To reflect the diversity of women with HIV in Canada, we initially hired 37 PRAs from British Columbia, Ontario, and Quebec, prioritizing women historically under-represented in research, including women who use or have used illicit drugs, and women living with HIV of other social identities including Indigenous, racialized, LGBTQ2S, and sex work communities, noting important points of intersection between these groups. RESULTS: Building on PRAs' lived experience, research capacity was supported through a comprehensive, multi-phase, and evidence-based experiential training curriculum, with mentorship and support opportunities provided at various stages of the study. Challenges included the following: being responsive to PRAs' diversity; ensuring PRAs' health, well-being, safety, and confidentiality; supporting PRAs to navigate shifting roles in their community; and ensuring sufficient time and resources for the translation of materials between English and French. Opportunities included the following: mutual capacity building of PRAs and researchers; community-informed approaches to study the processes and challenges; enhanced recruitment of harder-to-reach populations; and stronger community partnerships facilitating advocacy and action on findings. CONCLUSIONS: Community-collaborative studies are key to increasing the relevance and impact potential of research. For women living with HIV to participate in and benefit from HIV research, studies must foster inclusive, flexible, safe, and reciprocal approaches to PRA engagement, employment, and training tailored to regional contexts and women's lives. Recommendations for best practice are offered.

Assessing Research Activity and Capacity of Community-Based Organizations: Refinement of the CREAT Instrument Using the Delphi Method.

Community-based organizations (CBOs) are essential partners in community-engaged research, yet little is known about their research capacity. Community experts and organizations bring unique knowledge of the community to research partnerships, but standard validated measures of CBO research capacity do not yet exist. We report here on the refinement through a structured Delphi panel of a previously developed and piloted framework of CBO research capacity and an accompanying instrument, the Community REsearch Activity Assessment Tool (CREAT). A Delphi panel composed of twenty-three experts recruited from community (52%) and academic researchers (48%) from around the USA participated in five rounds of review to establish consensus regarding framework domains, operational definitions, and tool items. Panelists rated the importance of items on a 5-point Likert scale and assessed for the inclusion and language of items. Initial rounds of review began with reviewing the framework and definitions, with subsequent rounds including review of the full instrument. Concluding rounds brought back items that had not yet reached consensus for additional review. Median response values (MRV) and intra-quartile ranges (IQR) were calculated for each Likert item. Items with an MRV > 3.5 were deemed as having reached consensus and were retained. Language changes were made for items with MRV > 2.0 and < 3.5 and an IQR > 1.5. Items with MRV < 2.0 were excluded from the final tool. Panelist response rate was high (> 75%). Consensus was achieved for the inclusion of all domains, subdomains and operational definitions except "evidence-based practices." Extensive changes to the CREAT instrument were made for clarification, to provide additional detail and to ensure applicability for CBOs. The CREAT framework and tool was refined through input from community and academic researchers. Availability of a validated tool to assess research capacity of CBOs will support targeted research capacity building for community organizations and partners, thus strengthening collaborations.

The LEADER trial in type 2 diabetes: Were the characteristics and outcomes of the participants representative?

AIMS: To compare the characteristics and outcomes of people with type 2 diabetes recruited to the LEADER trial to those of participants in the contemporaneous community-based Fremantle Diabetes Study Phase II (FDS2) who fulfilled LEADER entry criteria. METHODS: Baseline characteristics of LEADER and LEADER-eligible FDS2 participants were compared using bivariate methods. Incidence rates of the primary (nonfatal myocardial infarction, nonfatal stroke, cardiovascular disease (CVD) death) and other outcomes in the LEADER placebo group were compared with those in LEADER-eligible FDS2 participants during 3.8 years after entry, the median LEADER follow-up. RESULTS: Of 1551 FDS2 type 2 participants, 323 (20.8%) were LEADER-eligible. Compared with the LEADER sample, they were an average 6 years older, and were less likely to be male, obese and to have prior CVD. There were 3.9 and 2.9 primary outcomes/100 patient-years in LEADER placebo-treated and FDS2 LEADER-eligible patients, respectively. Incidence rates for first myocardial infarction and stroke were 1.9 and 2.1 events/100 patient-years and 1.1 and 1.0 events/100 patient-years, respectively. FDS2 LEADER-eligible patients had a lower CVD death rate of 0.8 versus 1.6/100 patient-years in the LEADER placebo group, but their non-CVD mortality was greater (2.1 versus 1.0/100 patient-years). CONCLUSIONS: These data suggest recruitment bias in type 2 diabetes CVD outcome trials.

The HIV SEERs Project: A Qualitative Analysis of Program Facilitators' Experience.

HIV-related stigma creates barriers to HIV testing, medication adherence, and retention in care. Guided by the principles of community-based participatory research (CBPR) and in collaboration with community health workers (CHWs), the Stigma-reduction through Education, Empowerment, and Research (SEERs) project was developed with and for youth living in Nakuru, Kenya to reduce HIV-related stigma. The purpose of this qualitative study was to examine the experiences of the CHWs serving as SEERs facilitators. To evaluate SEERs, 37 facilitators completed open-ended survey questions to gather their experiences and recommendations for future program implementation and sustainability. Participants' mean age was 30.58 (standard deviation = 9.62), ranging from ages 18 to 53. Thematic content analysis was used to categorize (a) facilitators' experiences and the community impact of the SEERs project, (b) lessons learned, and (c) challenges to sustainability. Recommendations will be used to modify the SEERs project, improve implementation and sustainability strategies, and may provide guidance for similar CBPR projects.

Community groups or mobile phone messaging to prevent and control type 2 diabetes and intermediate hyperglycaemia in Bangladesh (DMagic): a cluster-randomised controlled trial.

BACKGROUND: Strategies are needed to prevent and control type 2 diabetes and intermediate hyperglycaemia, which together affect roughly a third of adults in Bangladesh. We aimed to assess the effects of mHealth and community mobilisation on the prevalence of intermediate hyperglycaemia and diabetes among the general adult population in rural Bangladesh, and to assess the effect of these interventions on the incidence of type 2 diabetes among people with intermediate hyperglycaemia within the study population. METHODS: DMagic was a three-arm, cluster-randomised trial of participatory community mobilisation, mHealth mobile phone messaging, and usual care (control) in 96 villages (population roughly 125 000) in Bangladesh. Community mobilisation involved 18 monthly group meetings, led by lay facilitators, applying a participatory learning and action (PLA) cycle focused on diabetes prevention and control. mHealth involved twice-weekly voice messages over 14 months promoting behaviour change to reduce diabetes risk. The primary outcomes were the combined prevalence of type 2 diabetes and intermediate hyperglycaemia in the overall population at the end of the intervention implementation period, and 2-year cumulative incidence of type 2 diabetes in a cohort with intermediate hyperglycaemia at baseline. Primary outcomes were assessed through fasting blood glucose concentrations and 2-h oral glucose tolerance tests among a cross-section of adults aged 30 years and older and a cohort of individuals identified with intermediate hyperglycaemia. Prevalence findings are based on a cross-sectional survey at the end of the study; incidence findings are based on 2-year follow-up survey of a cohort of individuals identified with intermediate hyperglycaemia through a cross-sectional survey at baseline. We also assessed the cost-effectiveness of the interventions. This trial is registered with the ISRCTN registry, number ISRCTN41083256, and is completed. FINDINGS: The study took place between June 27, 2015, and June 28, 2018, with the PLA intervention running in 32 villages from June, 2016, to December, 2017, and the mHealth intervention running in 32 villages from Oct 21, 2016, to Dec 24, 2017. End-of study prevalence was assessed in 11 454 individuals and incidence in 2100 individuals. There was a large reduction in the combined prevalence of type 2 diabetes and intermediate hyperglycaemia in the PLA group compared with the control group at the end of the study (adjusted [for stratification, clustering, and wealth] odds ratio [aOR] 0·36 [0·27-0·48]), with an absolute reduction of 20·7% (95% CI 14·6-26·7). Among 2470 adults with intermediate hyperglycaemia at baseline, 2100 (85%) were followed-up at 2 years. The 2-year cumulative incidence of diabetes in this cohort was significantly lower in the PLA group compared with control (aOR 0·39, 0·24-0·65), representing an absolute incidence reduction of 8·7% (3·5-14·0). There was no evidence of effect of mHealth on combined prevalence of intermediate hyperglycaemia and diabetes (aOR 0·93, 0·74-1·16) or the incidence of diabetes (1·02, 0·73-1·43). The incremental cost-effectiveness ratios for PLA were INT$316 per case of intermediate hyperglycaemia or type 2 diabetes prevented and $6518 per case of type 2 diabetes prevented among individuals with intermediate hyperglycaemia. INTERPRETATION: Our data provide strong evidence to support the use of community mobilisation based on PLA to prevent type 2 diabetes in this rural Bangladeshi population. Despite raising knowledge and awareness of diabetes, the mHealth intervention did not change disease outcomes in our population. Replication studies in other populations should be a priority. FUNDING: UK Medical Research Council.

Community engagement in the Aboriginal Families Study: Strategies to promote participation.

BACKGROUND: Aboriginal women and families are under-represented in Australian research on pregnancy and childbirth. The Aboriginal Families Study aimed to investigate the views and experiences of a representative sample of women giving birth to an Aboriginal baby in South Australia between July 2011 and June 2013, using methods designed to respect Aboriginal culture and communities. METHODS: A team of 12 Aboriginal researchers facilitated community engagement and recruitment of Aboriginal and non-Aboriginal mothers of Aboriginal infants in urban, regional and remote areas of South Australia over a two-year period. RESULTS: A total of 344 women took part, around a quarter of all Aboriginal women giving birth in South Australia in the study period (39% urban, 35% regional and 25% from remote areas). Participants were representative in relation to maternal age (mean age of 25 years, range=15-43 years). Over half of women (56%) first heard about the study via a member of the fieldwork team making contact with them through community connections. Other major sources of recruitment were: Aboriginal health services/programs (20%) and public maternity hospitals (16%). Almost all of the women (95%) recruited via community networks of the fieldwork team completed the questionnaire. In contrast, 51% of women recruited via public hospitals completed the questionnaire (odds ratio=0.1, 95% confidence interval 0.0-0.1, p<0.001). CONCLUSIONS: Aboriginal researchers' community knowledge and leadership is critical to the conduct of successful Aboriginal health research. High levels of participation in research by 'harder to reach' populations are achievable when researchers take time to build relationships and work in partnership with communities.

Combining participatory action research and appreciative inquiry to design, deliver and evaluate an interdisciplinary continuing education program for a regional health workforce.

Objective Continuing education (CE) is essential for a healthcare workforce, but in regional areas of Australia there are challenges to providing and accessing relevant, reliable and low-cost opportunities. The aim of the present study was to collaborate with the local regional healthcare workforce to design, deliver and evaluate an interdisciplinary CE (ICE) program. Methods A participatory action research (PAR) model combined with an appreciative inquiry (AI) framework was used to design, deliver and evaluate an ICE program. A focus group of 11 health professionals developed an initial program. Evaluation data from 410 program participants were analysed using AI. Results The ICE program addressed the CE barriers for the regional healthcare workforce because the locally derived content was delivered at a reasonable cost and in a convenient location. Program participants identified that they most valued shared experiences and opportunities enabling them to acquire and confirm relevant knowledge. Conclusion ICE programs enhance interdisciplinary collaboration. However, attendance constraints for regional healthcare workforce include location, cost, workplace and personal factors. Through community engagement, resource sharing and cooperation, a local university and the interdisciplinary focus group members successfully designed and delivered the local education and research nexus program to address a CE problem for a regional healthcare workforce. What is known about the topic? Participation in CE is mandatory for most health professionals. However, various barriers exist for regional health workers to attending CE. Innovative programs, such as webinars and travelling workshops, address some of the issues but create others. Bringing various health workers together for the simultaneous education of multiple disciplines is beneficial. Collectively, this is called ICE. What does this paper add? Using PAR combined with AI to design an ICE program will focus attention on the enablers of the program and meet the diverse educational needs of the healthcare workforce in regional areas. Engaging regional health professionals with a local university to design and deliver CE is one way to increase access to quality, cost-effective education. What are the implications for practitioners? Regional healthcare workers' CE needs are more likely to be met when education programs are designed by them and developed for them. ICE raises awareness of the roles of multiple healthcare disciplines. Learning together strengthens healthcare networks by bolstering relationships through a greater understanding of each other's roles. Enriching communication between local health workers has the potential to enhance patient care.

Using Risk Communication Strategies for Zika Virus Prevention and Control Driven by Community-Based Participatory Research.

Background: In this study, we use community-based participatory processes to engage community and academic partners in a meaningful exchange to identify and pilot test risk communication strategies for Zika virus prevention and control. Methods: Community members were actively involved in planning, developing, and implementing a risk communication initiative. Qualitative and quantitative data gathered through individual interviews, focus groups, and community advisory board input provided information for the identification of relevant risk communication strategies to increase the understanding about Zika virus and to promote behavior change. To examine its impact we obtained baseline and follow-up data from a random sample of 75 community residents. A face-to-face interview was conducted to assess community members' knowledge, attitudes, and behaviors regarding Zika virus infection. Results: Study activities focused on three risk communication strategies: Zika awareness health fair, health education through theater, and community forums and workshops. The risk communication initiative was implemented over a two-month period. Findings from baseline and follow-up data demonstrated significant positive changes in respondents' recognition of personal and community responsibility for the prevention of Zika infection, increased knowledge of prevention strategies, and enhanced engagement in preventive behaviors for mosquito control. Conclusion: Our findings sustain the benefits of community based participatory research for the design and implementation of risk communication strategies that are relevant to enable residents in low-income communities to take informed decisions for the protection against Zika virus and other mosquito-borne diseases.

Community-informed research on malaria in pregnancy in Monrovia, Liberia: a grounded theory study.

BACKGROUND: Liberia is a West African country that needs substantial investment to strengthen its National Malaria Control Programme (NMCP), which was disrupted during the 2014-2016 Ebola epidemic. As elsewhere, Liberian pregnant women are especially vulnerable to malaria. Understanding prevention and treatment-seeking behaviours among the population is crucial to strategize context-specific and women-centred actions, including locally-led malaria research, to improve women's demand, access and use of NMCP strategies against malaria in pregnancy. METHODS: In 2016, after the Ebola crisis, a qualitative inquiry was conducted in Monrovia to explore populations' insights on the aetiology, prevention and therapeutics of malaria, as well as the community and health workers' perceptions on the utility of malaria research for pregnant women. In-depth interviews and focus group discussions were conducted among pregnant women, traditional community representatives and hospital staff (n = 38), using a feminist interpretation of grounded theory. RESULTS: The narratives indicate that some Liberians believed in elements other than mosquito bites as causes of malaria; many had a low malaria risk perception and disliked current effective prevention methods, such as insecticide-treated nets; and some would resort to traditional medicine and spiritual care to cure malaria. Access to clinic-based malaria care for pregnant women was reportedly hindered by lack of financial means, by unofficial user fees requested by healthcare workers, and by male partners' preference for traditional medicine. The participants suggested that malaria research in Liberia could help to design evidence-based education to change current malaria prevention, diagnostic and treatment-seeking attitudes, and to develop more acceptable prevention technologies. CONCLUSION: Poverty, insufficient education on malaria, corruption, and poor trust in healthcare establishment are structural factors that may play a greater role than local traditional beliefs in deterring Liberians from seeking, accessing and using government-endorsed malaria control strategies. To increase access to and uptake of preventive and biomedical care by pregnant women, future malaria research must be informed by people's expressed needs and constructed meanings and values on health, ill health and healthcare.

SALTO - Study Protocol and Rationale of a Community-Oriented Obesity Prevention Program in the Kindergarten.

BACKGROUND: The prevalence of early childhood overweight and obesity in Austria has reached average European levels of 20% in boys and 18% in girls. The rationale and study protocol of SALTO, Salzburg Together against Obesity will be presented, which is aimed to assist adults in increasing the rate of 4- to 6-year-old children with a healthy body weight. METHODS: A controlled longitudinal sequential study design consisting of 14 intervention (IK) and 8 control (CK) kindergarten was used to investigate the effect of actions tailored for teachers and parents on BMI among 4- to 6-year-old children. The study launched in November 2014 was approved by the ethics committee of the University of Salzburg. RESULTS: 681 children, 181 parents (119 mothers, 62 fathers) and 30 teachers were investigated until October 2016. Preliminary analyses revealed that more boys (19%) and fathers (60% IK, 43% CK) were overweight and obese than girls (16%) and mothers (19% IK, 20% CK). CONCLUSION: The challenges faced by the SALTO staff in the implementation of health-promoting actions in the kindergarten are manifold. The Community-Oriented Core Setting (COCS) intervention approach will show whether the actions will reduce the percentage of obesity and be sustainable in the long term.