Research protocol for bridging research, accurate information and dialogue (BRAID)-clinical trials: a mixed-methods study of a community-based intervention to improve trust and diversify participation in clinical trials.

Cultural beliefs, personal experiences, and historic abuses within the healthcare system-rooted in structural racism-all contribute to community distrust in science and medicine. This lack of trust, particularly within underserved communities, contributes to decreased participation in clinical trials and a lack of representation in the data. Open dialogue about community concerns and experiences related to research participation and medical care processes can help build trust and change attitudes and behaviors that affect community health. This protocol outlines an approach to increase trust in science and clinical trials among communities in the Bronx, New York that are typically underrepresented in research data. Bridging Research, Accurate Information and Dialogue (BRAID) is a two-phased, evidence-based community engagement model that creates safe spaces for bilateral dialogues between trusted community messengers, and clinicians and scientists. The team will conduct a series of BRAID Conversation Circles on the topic of clinical trials with local trusted community messengers. Participants will be members of the community who are perceived as "trusted messengers" and can represent the community's voice because they have insight into "what matters" locally. Conversation Circles will be audiotaped, transcribed, and analyzed to identify emergent challenges and opportunities surrounding clinical trial participation. These key themes will subsequently inform the codesign and co-creation of tailored messages and outreach efforts that community participants can disseminate downstream to their social networks. Surveys will be administered to all participants before and after each Conversation Circle to understand participants experience and evaluate changes in knowledge and attitudes about clinical trials, including protections for research participants the advantages of having diverse representation. Changes in motivation and readiness to share accurate clinical trial information downstream will also be assessed. Lastly, we will measure participants dissemination of codesigned science messages through their social networks by tracking participant specific resource URLs of materials and videos posted on a BRAID website. This protocol will assess the effectiveness and adoptability of an innovative CBPR model that can be applied to a wide range of public health issues and has the potential to navigate the ever-changing needs of the communities that surround health systems.

Development and verification of community development index for improving functioning of aged people in rural districts (third report): data collection and analysis system on social mutual aid are desired for community development for elderly persons living in rural districts.

Objective: The author conducted a survey on social mutual aid and the social stimulative effect of older adults living in a rural district, and compared young old and old-old persons to clarify the roles of public health nurses in promoting community development. Materials and Methods: A cross-sectional study based on Andersen's Behavioral Model of Health Care Utilization was conducted with 2,500 residents aged 65 years or older of City A in Akita Prefecture. The study was conducted from April 8 to May 15, 2017. Participants were administered a questionnaire containing items on "social mutual aid in the rural district". Responses were recorded on a Likert scale. Results: As a result of factor analysis, the following four factors were extracted; [Blessing of a rural district and mutual help and assistance unique to a rural district], [Closeness of healthcare welfare service and family doctors in conjunction with their own health], [Decline of culture and community unique to rural districts accompanied by depopulation] and [Closeness of the town where they live]. Differences were observed in the closeness of social mutual aid and local societal stimulative effects, even between generations of old and old-old persons. In young-old persons, a negative correlation was observed between [Closeness of the town where they live] and other factors. In old-old persons, a negative correlation was found between [Decline of culture and community unique to rural districts accompanied by depopulation] and other factors. Conclusion: Since not only individual health indices but also local social mutual aid, which relates to individuals' influence on the construction of a Community-based Integrated Care System in a rural district, the author posits that a data collection and analysis system on social mutual aid would be beneficial for community development for older adults living in rural districts.

Integrated Community-Based Care for Dependent Older People Community Participation in Preparation for Recurrent Outbreaks of COVID-19.

Background: The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted family caregivers of older dependents, leading to fatigue, anxiety, depression, and financial burdens, which in turn diminish their quality of life. This study investigated the integration of community participatory systems in older care to address potential COVID-19 recurrence and develop policy proposals for the integrated care of dependent older people. Methods: An explanatory sequential design was used, with stratified random sampling across six provinces, resulting in a sample of 440 family caregiver dyads and 154 full-time community stakeholders (October 2021--May 2022). Five validated tools were employed, with a content validity of 0.91 and a Cronbach's alpha of 0.69. The data analysis included descriptive statistics and thematic analysis. Results: Among the 440 primary caregiver households, 42.73% of the older people had moderate dependence, 30.00% had severe dependence, and 27.27% had complete dependence, with common health issues, including chronic illness and comorbidities. Most older adults lived with their children/grandchildren, had insufficient income, and were informed about COVID-19 prevention measures. Family caregivers, predominantly female (average age 54), had multiple underlying conditions and provided an average of 37 hours of care per week, primarily communicating via phones or apps. The 154 stakeholders included public health volunteers and professional nurses, with an average age of 55 years, and were predominantly female (74.55%). They adhered strictly to COVID-19 precautions during their caregiving duties. This study highlights the impact of trust and COVID-19 perceptions on older care, emphasizing the need for specific forms of care, community support, and resources. Perceptions of "trust", "stay home", "self-care", and "distance" significantly influenced care for dependents. The findings will inform health and social workers' planning, operation, and training, addressing the specific care needs of dependent older adults. Conclusion: This study recommends policy interventions such as budget allocations for essential equipment, better compensation for community work, and the fostering of expertise in elder care. Emphasis is placed on fostering collaborative community agreements.

Prevalence of strabismus in Pakistan: a systematic review and meta-analysis.

Purpose: Strabismus is an ocular condition characterized by misalignment of the visual axis. The global prevalence of strabismus is about 2-3%, which varies between different countries and ethnicities. The aim of this study was to conduct a meta-analysis of studies, which had previously reported the prevalence of strabismus in Pakistan, in order to obtain the overall prevalence of strabismus in the country. Methods: All community-based studies reporting the prevalence of strabismus from Pakistan were searched using international databases and local ophthalmology journals. Information about sample size, number of individuals with strabismus, and location and duration of the study was recorded. Statistical analysis including heterogeneity testing, pooled prevalence calculation and regression analysis were done using the R software. Results: Heterogeneity tests, Pheterogeneity < .01, suggested high heterogeneity between the different studies. The pooled prevalence of strabismus was 0.7% [95% confidence interval (CI): 0.39%-1.23%] according to the random effects model, with a decreasing trend in prevalence from 1995 to 2020. Esotropia was more frequent than exotropia in both population-based and clinic-based studies. Conclusion: The prevalence of strabismus in Pakistan is comparatively lower than the worldwide prevalence, and it appears to be decreasing over the last three decades, consistent with global trends.

Impact of community-based multidomain preventive health program on healthcare utilisation among elderly persons in Singapore: a propensity score matched and difference-in-differences study.

OBJECTIVES: Ageing populations present substantial challenges for healthcare systems. Community-based health worker (CHW) interventions for promoting healthy ageing and preventing/managing non-communicable diseases have gained considerable attention in recent years. This study aimed to assess the impacts of a multidomain preventive health initiative delivered by CHWs, specifically the 'My Health Map (MHM)' programme, on participants' health service utilisation using a propensity score matching methodology. DESIGN, SETTING AND PARTICIPANTS: The multidomain MHM programme, which was implemented in Bukit Batok township, encompassed screenings, vaccinations, chronic disease management, counselling and socio-environmental interventions. Individuals, aged ≥40 years old, who received care at Ng Teng Fong General Hospital and were enrolled in the MHM programme constituted the intervention group. Outcomes of the intervention group were compared with a 1:1 propensity-matched comparison group at enrolment and 1-year follow-up. The outcome measures were emergency department (ED) utilisation and hospital admissions. Statistical evaluations were performed using χ2/non-parametric tests and difference-in-difference (DiD) estimation with a bias-adjusted generalised estimating equation (α=0.05). RESULTS: A comparable comparison group was formed with no significant differences in baseline characteristics between groups. Data from a total of 299 MHM participants (mean age 70.7 (SD 9.6); 62.5% women) and 299 matched comparisons (mean age 72.1 (SD 16.6); 61.5% women) were appraised. DiD analysis indicated a significant reduction in ED attendance (-16.7%, p<0.001) and hospital admission (-18.4%, p<0.001) among intervention participants than the comparison participants. CONCLUSIONS: The multidomain MHM programme proved effective in reducing ED attendances and hospital admissions in older adults. CHWs have the potential to serve as change agents in healthcare and should be systematically integrated into preventive health programmes.

A Technology-Based Intervention Impacts Quality of Life for Low-Income Older Adults by Reducing Loneliness and Improving Healthcare Self-Efficacy and Self-Rated Health.

This paper describes a technology program aimed at developing technical skills and confidence, reducing social isolation and loneliness, and increasing healthcare self-management and self-efficacy among older adults. We conducted a mixed-methods study using surveys collected at baseline and 12 months from 90 older adults. Focus group data (n = 7) collected at 12 months were examined for convergence with key quantitative outcomes, emergent value-related themes, and evaluation of program structure and staff. Outcome data showed improvements in loneliness (Cohen's d = -0.24, p = .004) (validated by qualitative data), self-rated health (d = 0.23, p = .011), and healthcare self-efficacy (d = 0.31, p = .004). Participants with higher healthcare self-efficacy (ß = 0.24, p = .03) and higher negative emotions (ß = 0.28, p = .01) had greater frequency of internet use to search for health information. Qualitative findings described program mechanisms supporting increases in self-efficacy, including increased technology use and confidence, and values statements demonstrating the meaningfulness of learning technology and its impact on multiple domains of quality of life.

Navigating Challenges and Opportunities in Community-Based Interventions for Promoting Active Aging: A Systematic Review of the Roles of Technology.

Background and Objectives: Researchers from different fields are increasingly interested in incorporating technology into community-based interventions that promote active aging. Yet, there lacks a comprehensive understanding of technology roles, posing challenges for designers seeking to maximize the intended impacts of such interventions. This systematic review aims to fill the gap by examining existing community-based interventions that integrate digital technologies to promote active aging. Research Design and Methods: Thirteen studies were screened, with a total of 14 interventions examined, following the PRISMA Guideline. Results: The challenges in designing and operating community-based interventions, the roles of technology in the interventions, and the caveats of utilizing technology during the process were identified. The review emphasizes the importance of overcoming challenges in community-based interventions and leveraging technology to enhance the intended impacts. Discussion and Implications: The findings underscore the need to understand technology's nuanced roles in community-based interventions for active aging. The article provides a starting point for accumulating knowledge and practice in utilizing technology to navigate the challenges and opportunities encountered in such interventions. It also sheds light on a notable gap: the lack of innovative and strategic approaches that harness digital interventions appropriately in community-based interventions. This emphasizes a crucial requirement for guidelines to assist designers, policymakers, and community staff in integrating technology appropriately into community-based interventions or implementing interventions that incorporate digital technologies at the community level.

Seroprevalence and risk factors for Lassa virus infection in South-West and North-Central Nigeria: a community-based cross-sectional study.

BACKGROUND: Understanding the level of exposure to Lassa virus (LASV) in at-risk communities allows for the administration of effective preventive interventions to mitigate epidemics of Lassa fever. We assessed the seroprevalence of LASV antibodies in rural and semiurban communities of two cosmopolitan cities in Nigeria with poorly understood Lassa epidemiology. METHODS: A cross-sectional study was conducted in ten communities located in the Abuja Municipal Area Council (AMAC), Abuja, and Ikorodu Local Government Area (LGA), Lagos, from February 2nd to July 5th, 2022. Serum samples collected from participants were analyzed for IgG and IgM antibodies using a ReLASV® Pan-Lassa NP IgG/IgM enzyme-linked immunosorbent assay (ELISA) kit. A questionnaire administered to participants collected self-reported sociodemographic and LASV exposure information. Seroprevalence of LASV IgG/IgM was estimated overall, and by study site. Univariate and multivariate log-binomial models estimated unadjusted and adjusted prevalence ratios (aPRs) and 95% confidence intervals (CI) for site-specific risk factors for LASV seropositivity. Grouped Least Absolute Shrinkage and Selection Operator (LASSO) was used for variable selection for multivariate analysis. RESULTS: A total of 628 participants with serum samples were included in the study. Most participants were female (434, 69%), married (459, 73%), and had a median age of 38 years (interquartile range 28-50). The overall seroprevalence was 27% (171/628), with a prevalence of 33% (126/376) in Abuja and 18% (45/252) in Lagos. Based on site-specific grouped LASSO selection, enrollment in the dry season (vs. wet; aPR, 95% CI: 1.73, 1.33-2.24), reported inconsistent washing of fruits and vegetables (aPR, 95% CI: 1.45, 1.10-1.92), and a positive malaria rapid test (aPR, 95% CI: 1.48, 1.09-2.00) were independently associated with LASV seropositivity in Abuja, whereas, only a self-reported history of rhinorrhea (PR, 95% CI: 2.21, 1.31-3.72) was independently associated with Lassa seropositivity in Lagos. CONCLUSIONS: The LASV seroprevalence was comparable to that in other areas in Nigeria. Our findings corroborate those from other studies on the importance of limiting human exposure to rodents and focusing on behavioral factors such as poor hygiene practices to reduce exposure to LASV.

Effect of community based health insurance on healthcare services utilization in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Community based health insurance (CBHI) is characterized by voluntary involvement, pooling of health risks and of funds occur within a community. It is becoming increasingly popular way to increase the use of healthcare services in low- and middle-income nations. Understanding the effect of CBHI on the level of health services utilization is a paramount for evidence based decision making. Hence, this study aimed to estimate the pooled effect of CBHI on health services utilization in Ethiopia. METHODS: Studies were searched from PubMed, Google scholar, Web of Science, Research4life, Science Direct, African Journal Online and national websites for grey literatures. We were adhered to the PRISMA guidelines. Cross sectional and quasi experimental studies were included. Studies were screened, and critically appraised for quality using Joanna Briggs Institute Critical Appraisal tools. The data were extracted using Microsoft excel and exported to STATA 17 and RevMan 5.4.1 for further analysis. Heterogeneity between studies was assessed using Cochran's Q statistic and quantified with I2. A random-effects model was used to estimate the pooled effect size. Subgroup analysis was done to show variations of the effect sizes across study years. RESULT: A total of 1501 studies were identified, out of which only 14 of them were included in the final meta-analysis. Health services utilization among CBHI members and non-members was 69.1% [95%CI (57.1-81.1%)] versus 50.9% [95%CI (40.6-61.3%)] respectively (difference in the effect was 18.2%). The CBHI members were nearly three folds more likely to utilize health services as compared with their counterparts [OR = 2.54, 95%CI: (1.81, 3.57). On average, CBHI users had 1.14 increased health facility visits as compared to non-insured, mean difference (MD) = 1.14 visits with 95% CI (0.65-1.63). CONCLUSION: The CBHI has a significantly increased health service utilization in Ethiopia. Hence, it will have a great contribution to meet the health for all agenda in resource limited countries.

Brownfields to Healthfields: A Retrospective Ripple Effect Mapping Evaluation in Three Rural Communities.

The environments in which we live influence our health behaviors and outcomes. The redevelopment of brownfields sites to health-promoting land uses may provide an array of benefits to individuals and communities, but these impacts can be particularly difficult to assess in rural communities using traditional evaluation approaches. This participatory evaluation aimed to explore the impacts of redeveloping rural brownfield sites into health-promoting land uses. Using a facilitated workshop-based Ripple Effects Mapping process, we evaluated three rural brownfields redevelopment sites across Appalachian portions of EPA Region 3 (mid-Atlantic). Adult members (n=32) of these communities participated in guided reflection on the redevelopment and subsequent impacts. Data were constructed as digital mind maps, then coded to the Community Capitals Framework by two authors coding independently. Member checking was conducted with representative workshop participants. Commonly cited impacts were site improvements, facilitation of social and physical activity, and engaging community identity. The most discussed community capitals were social and built; the least discussed capitals were natural and political. Rural brownfield redevelopment targeting physical activity provides the added benefit of engaging an array of community capitals, ultimately strengthening communities on the whole. Future directions for brownfield redevelopment evaluation are discussed.

Prevalence of Chronic Kidney Disease and its Association with Pesticide Exposure in Bargarh District, Odisha, India.

Background: Bargarh, a district in Odisha, is known for intense agricultural activities because of uninterrupted irrigation from the Hirakud reservoir. The number of chronic kidney disease (CKD) cases in the district is increasing rapidly. The present study assesses the prevalence of CKD and CKDu (of unknown etiology) in the district and its association with pesticide application. Materials and Methods: A door-to-door survey was conducted to find out the CKD hotspots in the different blocks of the district with the help of primary and community health centers. The prevalence of CKD in the identified hotspot villages was assessed using a random clustered sampling method along with the collection of data related to age, sex, occupation and source of drinking water. Soil and water samples collected from identified hotspot and nonhotspot villages were analyzed to assess the presence of nephrotoxic pesticide residues. Results: A total of 16 villages were identified with high CKD prevalence rates and designated as hotspot villages. Data indicate that about 21% of males under ≥ 40 years age group were found to be suffering from CKD. Cases of CKDu (85%) were more prominent in these hotspot villages. Analysis of soil and water samples demonstrated the presence of seven different nephrotoxic pesticides above the maximum residues levels (MRLs) in hotspot villages compared to nonhotspot villages. Conclusion: The presence of nephrotoxic pesticides above MRLs in the hotspot villages indicates their possible association with the onset and progression of CKD among the exposed population. Further research is needed to establish their causative association with CKDu in the study region.

A development and implementation of a preconception counseling program for black women and men in the southeastern United States: a pilot protocol.

Introduction: Racial/ethnic disparities in maternal mortality rates represent one of the most significant areas of disparities amongst all conventional population perinatal health measures in the U.S. The alarming trends and persistent disparities of outcomes by race/ethnicity and geographic location reinforce the need to focus on ensuring quality and safety of maternity care for all women. Despite complex multilevel factors impacting maternal mortality and morbidity, there are evidence-based interventions that, when facilitated consistently and properly, are known to improve the health of mothers before, during and after pregnancy. The objective of this project is to test implementation of pre-conception counseling with father involvement in community-based settings to improve cardiovascular health outcomes before and during pregnancy in southeastern United States. Methods and analysis: This study has two components: a comprehensive needs and assets assessment and a small-scale pilot study. We will conduct a community informed needs and assets assessment with our diverse stakeholders to identify opportunities and barriers to preconception counseling as well as develop a stakeholder-informed implementation plan. Next, we will use the implementation plan to pilot preconception counseling with father involvement in community-based settings. Finally, we will critically assess the context, identify potential barriers and facilitators, and iteratively adapt the way preconception counseling can be implemented in diverse settings. Results of this research will support future research focused on identifying barriers and opportunities for scalable and sustainable public health approaches to implementing evidence-based strategies that reduce maternal morbidity and mortality in the southeastern United States' vulnerable communities. Discussion: Findings will demonstrate that preconception counseling can be implemented in community health settings in the southeastern United States. Furthermore, this study will build the capacity of community-based organizations in addressing the preconception health of their clients. We plan for this pilot to inform a larger scaled-up clinical trial across community health settings in multiple southeastern states.

A digital iCBT intervention for social anxiety disorder in Quebec and Ontario: protocol for a multi-phase effectiveness-implementation study.

BACKGROUND: Social anxiety disorder (SAD) is one of the most prevalent anxiety disorders in Canada. Viable therapy options for the treatment of SAD include CBT being delivered virtually. In Australia, an innovative internet-delivered cognitive-behavioral therapy (iCBT) program for social anxiety has been developed, implemented, and demonstrated as effective. To make available high-quality and real-time evidence in response to the crucial need to access psychological services to meet population mental health needs, we propose to conduct a Canadian adaptation of the iCBT Shyness Program and to examine the program's effectiveness, and implementation in two Canadian provinces (Quebec and Ontario). METHODS: The overall study design is a hybrid effectiveness-implementation study of a quasi-experimental parallel group trial. Prior to implementing the iCBT Shyness Program, it will undergo an initial adaptation to the Canadian context and focus groups will be conducted with key actor groups to discuss the adaptations to the graphics, narration of the lessons, and this to better reflect varying socio-cultural context among Canadian French- and English-speaking populations. We will evaluate the effectiveness of the program in three parallel pathways reflecting real-world pathways: (1) self-refer to the intervention; (2) recommended by a health professional without guidance; and (3) recommended by a health professional, with low-intensity guidance. Data collection will be carried out at baseline, at the beginning of each lesson, 12-week and 6-month follow-up. Outcomes measured will include anxiety and depressive symptoms, psychological distress, disability, as well as health service utilization and satisfaction. Semi-structured interviews will then be conducted with study participants and health care providers to explore facilitating factors and barriers to the implementation of the iCBT adapted program. DISCUSSION: This study will provide evidence on the effectiveness, barriers and facilitating factors to implementing a low-intensity iCBT in the Canadian context for SAD, which will bridge an important care gap for undeserved populations in Canada with SAD. Findings will inform the eventual scaling up of the program in community-based primary care across Canada. This would improve equity of the health care system by helping a large number of Canadians to timely access to mental health services. TRIAL REGISTRATION: clinicaltrials.gov NCT06403995. Prospectively registered on 05/03/2024.

Exploring the Broader Benefits of Obesity Prevention Community-based Interventions From the Perspective of Multiple Stakeholders.

Community-based interventions (CBIs) show promise as effective and cost-effective obesity prevention initiatives. CBIs are typically complex interventions, including multiple settings, strategies and stakeholders. Cost-effectiveness evidence, however, generally only considers a narrow range of costs and benefits associated with anthropometric outcomes. While it is recognised that the complexity of CBIs may result in broader non-health societal and community benefits, the identification, measurement, and quantification of these outcomes is limited. This study aimed to understand the perspectives of stakeholders on the broader benefits of CBIs and their measurement, as well as perceptions of CBI cost-effectiveness. Purposive sampling was used to recruit participants from three stakeholder groups (lead researchers, funders, and community stakeholders of CBIs). Online semi-structured interviews were conducted, taking a constructivist approach. Coding, theme development and analysis were based on published guidance for thematic analysis. Twenty-six stakeholders participated in the interviews (12 lead researchers; 7 funders; 6 community stakeholders). Six key themes emerged; (1) Impacts of CBIs (health impacts and broader impacts); (2) Broader benefits were important to stakeholders; (3) Measurement of benefits are challenging; (4) CBIs were considered cost-effective; (5) Framing CBIs for community engagement (6) Making equitable impacts and sustaining changes-successes and challenges. Across all stakeholders, broader benefits, particularly the establishment of networks and partnerships within communities, were seen as important outcomes of CBIs. Participants viewed the CBI approach to obesity prevention as cost-effective, however, there were challenges in measuring, quantifying and valuing broader benefits. Development of tools to measure and quantify broader benefits would allow for more comprehensive evaluation of the cost-effectiveness of CBIs for obesity prevention.

Serum TNFα and IL-17A levels may predict increased depressive symptoms: findings from the Shika Study cohort project in Japan.

BACKGROUND: Low-grade systemic inflammation may be a key player in the immune activation that has been reported for mental health deterioration. We hypothesised that elevated serum levels of inflammatory cytokines increase neuroinflammation and exacerbate depressive symptoms. METHODS: The participants were part of a cohort study for whom data was available for both 2015 and 2019. In 2015, blood samples were collected from 232 participants. Their depressive symptoms were assessed both 2015 and 2019 using the Centre for Epidemiologic Studies Depression Scale (CES-D) (n = 33). The multiplex immunoassay system (Luminex® 200) was used to measure the serum concentrations of IL-6, IL-10, IL-12, IL-17A and TNFα. Data were analysed using linear models with the level of significance considered to be p < 0.05. RESULTS: After controlling for age, BMI, smoking and alcohol consumption, in 2015 the serum concentrations of IL-17A and TNFα in 2015 were significantly positively associated with the CES-D scores of women (standardised ß (B) = .027, p < 0.01 and B = 0.26, p < 0.01, respectively). The serum concentrations of IL-17A and TNFα of men were significantly positively associated with the CES-D scores of 2019 (B = 0.62, p = 0.02 and B = 0.59, p = 0.02, respectively). CONCLUSIONS: In this cross-sectional study, we found a significant positive correlation between the depressive symptoms and serum TNFα and IL-17A levels of women. In addition, our longitudinal findings suggest the possibility that TNFα and IL-17A could elevate the depressive symptoms of men.

Effective community-based interventions to prevent and control infectious diseases in urban informal settlements in low- and middle-income countries: a systematic review.

BACKGROUND: The impact of rapid urbanization taking place across the world is posing variegated challenges. Especially in terms of communicable disease, the risk is more concentrated in urban poor areas where basic amenities are inadequate. This systematic review synthesizes evidence on the effective community-based interventions (CBIs) aimed at preventing and controlling infectious diseases among the urban poor in low- and middle-income countries (LMICs). METHODS: This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. A comprehensive search across five major databases was conducted to capture literature on CBIs published between 2011 and 2021. Scientific articles of any design that reported any type of CBIs effective in preventing and controlling infectious diseases (tuberculosis, diarrhea, typhoid, dengue, hepatitis B and C, influenza, and COVID-19) were included. Screening and selection of studies were done by two pairs of independent researchers using the predefined eligibility criteria. The risk of bias in included studies was assessed using the modified checklist outlined in the Cochrane Handbook for Systematic Reviews of Interventions and Effective Public Health Practice Project (EPHPP). Analysis of effective CBIs was guided by the conceptual framework for integrated CBIs for neglected tropical diseases (NTDs), and narrative synthesis was carried out. Geographical restrictions were limited to LMICs and papers published in English. RESULTS: Out of 18,260 identified papers, 20 studies met the eligibility criteria and were included in this review. Community-based screening and socio-economic support, community-based vector control, behavior change communication, capacity building of the community health workers (CHWs), health education, and e- and m-health interventions were found as effective CBIs. Diversified CBIs were found to be effective for specific diseases, including tuberculosis (TB), diarrhea, dengue, influenza and ARI, and hepatitis B and C. Bundling of interventions were found to be effective against specific diseases. However, it was difficult to isolate the effectiveness of individual interventions within the bundle. The socio-cultural context was considered while designing and implementing these CBIs. CONCLUSION: The effectiveness of an intervention is inextricably linked to social context, stakeholder dimensions, and broader societal issues. System approach is recommended, emphasizing context-specific, multi-component interventions that address social determinants of health. Integrating these interventions with public health strategies and community involvement is crucial for sustainable outcomes. These findings can guide the design of future interventions for better prevention and control of communicable diseases in urban poor areas. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021278689.

A Nunavut community-directed Inuit youth mental wellness initiative: making I-SPARX fly.

Inuit youth in Nunavut (NU) are resilient but face a protracted suicide crisis. The SPARX serious game and e-intervention, developed originally in New Zealand, teaches youth cognitive behavioural therapy (CBT) skills to ameliorate stress and depression. Inuit youth in NU reviewed and culturally adapted SPARX and an existing wellness outcome measure for Inuit. One hundred and twenty-one youth, aged 13 to 24, across NU then tested, played, and evaluated I(nuit)-SPARX, showing improvement in several areas of wellbeing post-play. Youth completed a CBT skills survey, engaged in sharing circles to assess CBT skill retention, and shared their thoughts about the usefulness and cultural fit of I-SPARX with Inuit Qaujimajatuqangit (IQ). Communication Skills, Listening Skills, and Problem Solving emerged as the most helpful learned CBT skills, and NU youth provided real-world examples of using I-SPARX skills to support their mental wellness. Several principles of IQ were exemplified and upheld in the content of the adapted SPARX tool and the process of the project as a whole. Empirically grounded, asynchronous e-tools, developed in collaboration with Inuit communities to ensure cultural specificity, may support psychological wellness in communities where mental health resources are scarce.

Describing youth participatory evaluation of educational interventions as a key domain of the social determinants of health: protocol for a scoping review.

INTRODUCTION: Youth participatory evaluation is one model for monitoring global outcomes and assessing interventions to improve young people's health equity and well-being while embracing principles of participation and empowerment. Little is known about the use of this approach in practise. This scoping review will identify and synthesise descriptions of how youth participatory evaluation is enacted, to what extent it occurs, and describe the relationship between context and inclusion. METHODS AND ANALYSIS: Scoping review methods will adhere to those outlined by Arksey and O'Malley. The study will also follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. The review will use publicly available evaluation reports (grey literature) for programmes funded by the US National Science Foundation through the Advancing Informal science, technology, engineering and mathematics (STEM) Learning programme and whose reports are archived in the repository hosted by the Reimagining Equity and Values in Informal STEM education (REVISE) Center. This scoping review is limited to education, one of the domains of the social determinants of health, more precisely STEM education, due to the report publication parameters set by the REVISE Center repository. A research team member will download citations for and PDFs of reports. These citations and reports will be managed using Zotero and exported to Covidence, a web-based program designed to manage systematic and scoping reviews. Evaluation report selection will occur in a two-step process by trained coders with clear criteria. Inclusion criteria will include: (1) report is for an evaluation study; (2) evaluation has a focus on young people, aged 10-24; (3) evaluation is for a programme serving young people, aged 10-24; and (4) report written and uploaded to the REVISE Center repository between 2017 and 2022. All reports hosted on the REVISE Center repository are based in the USA and written in English. Data charting will also be done by trained coders and facilitated by Covidence and a codebook. Several procedures will be used to uphold rigour and consistency during this process. Data analysis will be done with Dedoose. ETHICS AND DISSEMINATION: Human subjects research approval will not be required. This scoping review will rely on publicly available evaluation reports. No human research participants will be involved in this review. Findings will be shared through dissemination strategies, such as peer-reviewed journals, international and national conferences, and social media affiliated with academic institutions and professional associations. STUDY REGISTRATION: This study is preregistered on Open Science Framework (https://osf.io/23jdx/). Registration DOI: https://doi.org/10.17605/OSF.IO/K6J98.

Family model diabetes self-management education and support in faith-based organizations in the Republic of the Marshall Islands: A study protocol.

INTRODUCTION: The Republic of the Marshall Islands (RMI) is an independent nation and a member of the United States (US) Affiliated Pacific Islands through a Compact of Free Association. Health disparities in the RMI are striking, with high rates of type 2 diabetes mellitus (T2DM). The International Diabetes Federation has documented age-adjusted prevalence of T2DM at 23.0 %, compared to the US (13.2 %) and globally (9.8 %). T2DM has a devastating impact on patients and their families. METHODS: The purpose of this article is to present the study protocol for the fully powered two-arm cluster randomized controlled trial using a wait-list control to evaluate the effectiveness of a Family Diabetes Self-Management Education and Support (Family DSMES) program when delivered in a group setting by community health workers (CHWs) in faith-based organizations (FBOs) in the RMI. The study used a community engaged approach, and the study protocol includes adaptations based on the results of our one-arm pilot study. SUMMARY: This study will provide new and innovative information on the effectiveness of Family DSMES delivered in a group setting by CHWs in FBOs in the RMI. The knowledge gained from this research will inform DSMES interventions conducted with Marshallese and other Pacific Islander communities, as well as DSMES interventions conducted in other low-resource countries.

Value for solidarity: a proxy for community understanding and acceptance of the basic principles of community-based health insurance in rural Ethiopia.

BACKGROUND: Solidarity is an aspect of human association that gives emphasis to the cohesive social bond that holds a group together and is valued and understood by all members of the group. A lack of understanding of the solidarity principle is one of the main reasons for low population coverage in microhealth insurance schemes. This study aimed to examine the extent to which people value solidarity and the factors that explain the differences. METHODS: A community-based cross-sectional study was carried out in two districts of northeast Ethiopia among 1232 randomly selected households which have ever been registered in a community-based health insurance scheme. Face-to-face interviews were conducted with household heads using a standardized questionnaire deployed to an electronic data collection platform. Solidarity was measured using three dimensions: income solidarity, risk solidarity, and cost coverage. Principal component analysis was used to construct composite variables, and the reliability of the tools was checked using Cronbach's alpha. A multivariable analysis was performed using the partial proportional odds model to determine the associations between variables. The degree of association was assessed using the odds ratio, and statistical significance was determined at 95% confidence interval. RESULTS: Three-quarters (75%) of the respondents rated risk solidarity as high, while 70% and 63% rated income solidarity and cost coverage as high, respectively. Place of residence (AOR = 2.23; 95% CI: 1.68, 2.94), wealth index (AOR = 1.51; 95% CI: 1.07, 2.12), self-rated health status (AOR = 1.64; 95% CI: 1.12, 2.40), trust in insurance schemes (AOR = 1.68; 95% CI: 1.22, 2.30), perceived quality of care (AOR = 1.75; 95% CI: 1.33, 2.31) and frequency of outpatient visits (AOR = 2.05; 95% CI: 1.30, 3.24) were significant predictors of value for solidarity. CONCLUSIONS: The community placed greater value for solidarity, indicating community understanding and acceptance of the core principles of microhealth insurance. Administrators of the insurance scheme, health authorities, and other actors should strive to create a transparent management system and improve access to high-quality health care, which will facilitate community acceptance of the insurance scheme and its guiding principles.