Identifying Caregiver Needs for Children With a Tracheostomy Living at Home.

This study sought to understand caregiver needs of children with tracheostomies (CWT) living at home and inform development of standardized tracheostomy simulation training curricula. Long-term goals are decreasing hospital readmissions following tracheostomy placement and improving family experiences while implementing a medical home model. We recruited caregivers of CWT and conducted semistructured interviews, subsequently recorded, transcribed, and analyzed for emerging themes using NVivo. Demographic data were collected via quantitative surveys. Twenty-seven caregivers participated. Emerging themes included the following: (1) caregivers felt overwhelmed, sad, frightened when learning need for tracheostomy; (2) training described as adequate, but individualized training desired; (3) families felt prepared to go home, but transition was difficult; (4) home nursing care fraught with difficulty and yet essential for families of CWT. Families of CWT have specific needs related to discharge training, resources, support, and home nursing. Provider understanding of caregiver needs is essential for child well-being, patient-/family-centered care, and may improve health outcomes.

The Role of Health Policies in Faith-based Institutions in Promoting Health and Changing Food Practices: The Philadelphia Ujima Experience.

BACKGROUND: The Philadelphia Ujima Health Collaborative uses a community-based participatory research framework to address nutrition in underserved communities. Participation in individual-level focused health promotion activities motivated two faith-based partners to develop wellness policies to better inform their health promoting practices, specifically around food served at church events. OBJECTIVES: This study investigated the effectiveness of church-based policies in influencing 1) organizational practices regarding food and beverages served and sold and 2) individual attitudes and practices toward healthy eating. METHODS: Congregants completed questionnaires assessing their knowledge and awareness of the policy as well as observed changes in institutional and personal practices. Additionally key informant interviews were conducted with ministry leaders and members. RESULTS: As a result of the wellness policies developed, sites increased consumption of fruits, vegetables, and water at events. Institutional barriers and lessons learned were identified. CONCLUSIONS: Effective community-academic partnerships using community participatory approaches with a health in all policies focus can improve health behaviors in diverse and underserved communities and engage them to play an active role in health promotion.

Promoting Policy Development through Community Participatory Approaches to Health Promotion: The Philadelphia Ujima Experience.

BACKGROUND: The Philadelphia Ujima Coalition for a Healthier Community (Philadelphia Ujima) promotes health improvement of girls, women, and their families using a gender framework and community-based participatory research approach to addressing gender-based disparities. Institutional policies developed through community-based participatory research approaches are integral to sustaining gender-integrated health-promotion programs and necessary for reducing gender health inequities. This paper describes the results of a policy analysis of the Philadelphia Ujima coalition partner sites and highlights two case studies. METHODS: The policy analysis used a document review and key informant interview transcripts to explore 1) processes that community, faith, and academic organizations engaged in a community participatory process used to develop policies or institutional changes, 2) types of policy changes developed, and 3) initial outcomes and impact of the policy changes on the target population. RESULTS: Fifteen policies were developed as a result of the funding from the U.S. Department of Health and Human Services Office on Women's Health. Policy changes included 1) healthy food options guidance, 2) leadership training on sexual and relationship violence, and 3) curricula and programming inclusion and expansion of a sex and gender focus in high school and medical school. CONCLUSIONS: Organizational practice changes and policies can be activated through individual-level interventions using a community participatory approach. This approach empowers communities to play an integral role in creating health-promoting policies.

Sexual Safety Planning as an HIV Prevention Strategy for Survivors of Domestic Violence.

Victims of domestic violence (DV) are not only subject to physical and emotional abuse but may also be at increased risk for less recognized dangers from infection with human immunodeficiency virus (HIV) and other sexually transmitted pathogens. Because of the close link between DV and sexual risk, women need to be educated about the consequences of acquiring a life-threatening sexually transmitted infection, risk reduction measures, and how to access appropriate HIV services for diagnosis and treatment. It is therefore critical for DV workers to receive sufficient training about the link between DV and HIV risk so that sexual safety planning can be incorporated into activities with their clients in the same way as physical safety plans. In this article, we discuss how the Many Hands Working Together project provides interactive training for workers in DV and DV-affiliated agencies to increase their knowledge about HIV and teach sexual safety planning skills to achieve HIV risk reduction.

Exploring the role of gender norms in nutrition and sexual health promotion in a piloted school-based intervention: The Philadelphia Ujima™ experience.

Perceptions of masculinity and femininity influence behaviors and can be identified in young children and adolescents (Brannon, 2004). Thus, adolescents' engagement in health risk or promoting behaviors is influenced by perceptions of masculinity and femininity and the differences in expectations, norms and responsibilities for girls and boys (WHO, 2007). Girls and boys have different needs, and gender-based interventions that consider similarities as well as differences are needed. A gender-based nutrition and sexual health promotion program was developed and piloted by the Philadelphia Ujima Coalition in a high school setting. To explore the gender differences in adolescents' perceptions of the influence of gender norms on weight, nutrition, physical activity, and sexual health and the implication of these differences in future gender-integrated health promotion programming for youth, a content analysis of student and facilitator debriefing forms were implemented for the participating schools. The content analysis was used to identify central themes, concepts gained, and overall impact of the intervention sessions. Overall, gender norms influence healthy eating practices and activity through influencing perceptions of body type in adolescents. Gender norms also influence sexual activity and decision making through influencing perceptions of beauty, masculinity, femininity, pressures and popular concepts related to sexual activity. Thus, interventions that address gender may more effectively promote health and wellness in adolescents.

Conducting a needs assessment for women and girls using a gender analysis framework: the Philadelphia Ujima Coalition for a Healthier Community experience.

INTRODUCTION: Despite a century of work toward gender equality, sex and gender disparities in health remain. Morbidity and mortality rates as well as quality of care received differ between men and women. The Philadelphia Ujima Coalition for a Healthier Community is composed of 23 academic, social service, wellness, faith-based, governmental, and healthcare organizations. The coalition, funded by the U.S. Department of Health and Human Services, Office on Women's Health, used a community participatory framework to conduct a gender-informed needs assessment of priority areas for women's health. METHODS: A four-tiered approach was used: 1) Coalition members identified priority areas; 2) we analyzed data from the Southeastern Pennsylvania 2010 Household Health Survey to identify gender differences in health; 3) using a gender analysis framework, we conducted interviews with "key informant" stakeholders; and 4) we conducted a community health assessment including 160 women. We used a participatory process to rank priority areas. RESULTS: Sex and gender disparities in health outcomes and behaviors were observed. Data were used to identify gender barriers and norms that influence health practices and behaviors, defining priority areas for the health of women and girls. Effective health promotion strategies were also identified. CONCLUSIONS: A gender-integrated needs assessment of girls and women can reveal priority areas and gender-related objectives that should be included in health promotion programming for girls and women.

The role of the obstetrician/gynecologist in the prevention of cardiovascular disease in women.

PURPOSE: A qualitative study was conducted to understand the current and potential role of the community obstetrician/gynecologist (OBGYN) in risk factor screening and prevention of cardiovascular disease. METHODS: A total of four focus group discussions were conducted among 46 OBGYN residents and practicing physicians in the mid-Atlantic region. MAIN FINDINGS: Five main thematic areas were identified including scope of practice, professional knowledge and skills in non-reproductive care, potential for liability, logistical and structural barriers, medical practice community, and support for collaborative care. There were no differences between residents and those in practice within and between cities. Comprehensive care was most often defined as excluding chronic medical care issues and most likely as focusing on screening and referring women. The OBGYN recognized their common role as the exclusive clinician for women was, in part, a consequence of patients' nonadherence with primary care referrals. Barriers and strategies were identified within each thematic area. CONCLUSION: Additional training, development of referral networks, and access to local and practice specific data are needed to support an increased role for the OBGYN in the prevention of cardiovascular disease in women. Establishment of evidence-based screening and referral recommendations, specific to women across the age spectrum, may enable clinicians to capitalize on this important prevention opportunity. Longer term, and in concert with health care reform, a critical evaluation of the woman's place in the center of her medical home, rather than any one site, may yield improvements in health outcomes for women.