Parents' User Experience Accessing and Using a Web-Based Map of COVID-19 Recommendations for Health Decision-Making: Qualitative Descriptive Study.

BACKGROUND: The eCOVID19 Recommendations Map & Gateway to Contextualization (RecMap) website was developed to identify all COVID-19 guidelines, assess the credibility and trustworthiness of the guidelines, and make recommendations understandable to various stakeholder groups. To date, little has been done to understand and explore parents' experiences when accessing and using the RecMap website for COVID-19 health decision-making. OBJECTIVE: To explore (1) where parents look for COVID-19 health information and why, (2) parents' user experience when accessing and using the RecMap website to make health decisions, and (3) what knowledge mobilization activities are needed to increase parents' awareness, use, and engagement with the RecMap website. METHODS: We conducted a qualitative descriptive study using semistructured interviews and a think-aloud activity with parents of children aged 18 years or younger living in Canada. Participants were asked to provide feedback on the RecMap website and to "think aloud" as they navigated the website to find relevant COVID-19 health recommendations. Demographic information was collected using a web-based questionnaire. A hybrid deductive and inductive thematic approach guided analysis and data synthesis. RESULTS: A total of 21 participants (13/21, 62% mothers) were interviewed and participated in a think-aloud activity. The data were categorized into four sections, representative of key elements that deductively and inductively emerged from the data: (1) parent information seeking behaviors and preferences for COVID-19, (2) RecMap website usability, (3) perceived usefulness of the RecMap website, and (4) knowledge mobilization strategies to increase awareness, use, and engagement of the RecMap website. Parents primarily used the internet to find COVID-19 information and focused on sources that they determined to be credible, trustworthy, simple, and engaging. As the pandemic evolved, participants' information-seeking behaviors changed, specifically their topics of interest and search frequency. Most parents were not aware of the RecMap website before this study but found satisfaction with its concept and layout and expressed intentions to use and share it with others. Parents experienced some barriers to using the RecMap website and suggested key areas for improvement to facilitate its usability and perceived usefulness. Recommendations included a more user-friendly home page for lay audiences (separate public-facing user interface), improving the search and filter options, quicker navigation, clearer titles, more family-friendly graphics, and improving mobile-friendly access. Several strategies to disseminate the RecMap website were also expressed, including a mix of traditional and nontraditional methods (handouts and social media) in credible and high-traffic locations that parents frequent often. CONCLUSIONS: Overall, parents liked the concept of the RecMap website but had some suggestions to improve its usability (language, navigation, and website interface). These findings can be used to improve the RecMap website for parents and offer insight for the development and dissemination of effective web-based health information tools and resources for the general public.

Development and evaluation of a remote training strategy for the implementation of mental health evidence-based practices in rural schools: pilot study protocol.

BACKGROUND: An increasing number of schools in rural settings are implementing multi-tier positive behavioral interventions and supports (PBIS) to address school-climate problems. PBIS can be used to provide the framework for the implementation of evidence-based practices (EBPs) to address children's mental health concerns. Given the large service disparities for children in rural areas, offering EBPs through PBIS can improve access and lead to better long-term outcomes. A key challenge is that school personnel need technical assistance in order to implement EBPs with fidelity and clinical effectiveness. Providing ongoing on-site support is not feasible or sustainable in the majority of rural schools, due to their remote physical location. For this reason, remote training technology has been recommended for providing technical assistance to behavioral health staff (BHS) in under-served rural communities. OBJECTIVES: The purpose of this study is to use the user-centered design, guided by an iterative process (rapid prototyping), to develop and evaluate the appropriateness, feasibility, acceptability, usability, and preliminary student outcomes of two online training strategies for the implementation of EBPs at PBIS Tier 2. METHODS: The study will employ a pragmatic design comprised of a mixed-methods approach for the development of the training platform, and a hybrid type 2, pilot randomized controlled trial to examine the implementation and student outcomes of two training strategies: Remote Video vs. Remote Video plus Coaching. DISCUSSION: There is a clear need for well-designed remote training studies focused on training in non-traditional settings. Given the lack of well-trained mental health professionals in rural settings and the stark disparities in access to services, the development and pilot-testing of a remote training strategy for BHS in under-served rural schools could have a significant public health impact. ETHICS AND DISSEMINATION: The project was reviewed and approved by the institutional review board. Results will be submitted to ClinicalTrials.gov and disseminated to community partners and participants, peer-reviewed journals, and academic conferences. TRIAL REGISTRATION: ClinicialTrials.gov, NCT05034198 and NCT05039164.

Perspectives From French and Filipino Parents on the Adaptation of Child Health Knowledge Translation Tools: Qualitative Exploration.

BACKGROUND: A number of evidence-based knowledge translation (KT) tools for parents of children with acute health conditions have been developed. These tools were created and tested with parental input and disseminated to groups proficient in English. Therefore, it is unclear whether they are useful for populations that are more diverse. To enhance the reach of our current and future KT tools, language translation and cultural adaptations may promote relevance for previously underserved knowledge users. OBJECTIVE: This study aims to explore and understand considerations for the cultural and linguistic adaptation of a KT tool in French and Filipino communities. METHODS: A KT tool (whiteboard animation video) describing the signs and symptoms of croup was originally developed in English to provide parents with evidence-based information couched within a narrative reflecting parents' experiences with the condition. This KT tool was adapted (linguistics and imagery) for French- and Tagalog-speaking parents and caregivers through feedback from key stakeholders. The videos were presented to the respective language speakers for usability testing and discussion. Participants were asked to view the KT tool, complete a usability survey, and participate in semistructured interviews. Audio recordings from the interviews were transcribed verbatim, translated into English, and analyzed for relevant themes by using thematic analysis. RESULTS: French- (n=13) and Tagalog-speaking (n=13) parents completed the usability survey and were interviewed. Although analyzed separately, both data sets produced similar findings, with key themes relating to understanding, relatability, and accessibility. Both the French and Tagalog groups reported that the video and other KT tools were useful in their adapted forms. Participants in both groups cautioned against using verbatim vocabulary and suggested that cultural competency and understanding of health languages were essential for high-quality translations. Parents also discussed their preference for videos with diverse visual representations of families, home environments, and health care workers, as such videos represent their communities more broadly. CONCLUSIONS: French and Filipino parents appreciated having KT tools in their first language; however, they were also supportive of the use of English KT products. Their suggestions for improving the relatability and communication of health messages are important considerations for the development and adaptation of future KT products. Understanding the needs of the intended end users is a crucial first step in producing relevant tools for health evidence dissemination.

Feasibility of a birth-cohort in Pakistan: evidence for better lives study.

BACKGROUND: Evidence for Better Lives Study Foundational Research (EBLS-FR) is a preliminary endeavor to establish the feasibility of a global birth cohort, and within this feasibility study, piloting the research instrument, with participants from eight lower middle-income countries across the globe. It aims to investigate mediators and moderators of child development and wellbeing; it envisages informing policy and practice change to promote child health and wellbeing globally. Pakistan is one of the resource poor lower middle-income country (LMIC) taking part in this global birth cohort; we report the feasibility of establishing such a birth cohort in Pakistan. METHOD: From March 2019 to July 2019, 153 third trimester pregnant women were identified, using community health worker registers, and approached for baseline demographics and a number of maternal wellbeing, mental health, support-related information, and stress-related biomarkers from bio-samples in a peri-urban area of Islamabad Capital Territory. One hundred fifty of these women gave consent and participated in the study. From October 2019 to December 2019, we re-contacted and were able to follow 121 of these women in the 8-24 weeks postnatal period. All interviews were done after obtaining informed consent and data were collected electronically. RESULTS: One hundred fifty (98.0%) third trimester pregnant women consented and were successfully interviewed, 111 (74.0%) provided bio-samples and 121 (80.6%) were followed up postnatally. Their mean age and years of schooling was 27.29 (SD = 5.18) and 7.77 (SD = 4.79) respectively. A majority (82.3%) of the participants were housewives. Nearly a tenth were first time mothers. Ninety-two (61.3%) of the women reported current pregnancy to have been unplanned. Overall wellbeing and mental health were reported to be poor (WHO-5 mean scores 49.41 (SD = 32.20) and PHQ-9 mean scores 8.23 (SD = 7.0)). Thirty-eight (21.8%) of the women reported four or more adverse childhood experiences; 46 (31.3%) reported intimate partner violence during their current pregnancy. During the postnatal follow up visits, 72 (58.0%) of the women reported breastfeeding their infants. CONCLUSION: The foundational research demonstrated that Pakistan site could identify, approach, interview, and follow up women and children postnatally, with a high response rates for both the follow up visits and bio-samples. Therefore, a future larger-scale pregnancy birth cohort study in Pakistan is feasible.

Implementation of targeted mental health interventions in urban schools: Preliminary findings for impact of training strategy on program fidelity.

School-based mental health programs are increasingly recognized as methods by which to improve children's access to evidence-based practices (EBPs), particularly in urban under resourced communities. School-wide positive behavior interventions and supports (PBIS) is one approach to integrating mental health services into school-based programming; however, school providers require training and support to implement programs as intended. We have conducted a randomized controlled trial to compare two models for training school-based personnel to deliver group EBPs to children at high risk of developing internalizing or externalizing problems. School personnel (N = 24) from 6 schools in a large urban school district were trained with either a basic training and consultation strategy, or an enhanced training and consultation strategy. Preliminary findings show that the enhanced strategy resulted in 9% higher content fidelity than the basic strategy. School personnel who were switched to the basic strategy had slightly lower content fidelity for the last two years of the trial and school personnel who continued to receive basic consultation during the step-down phase saw their fidelity decline. The two conditions did not differ with regard to process fidelity.

As tutelas de urgência na judicialização da saúde e a medicina baseada em evidências / Injunctions on health judicialization and evidenced-based medicine

O presente ensaio tem por objetivo abordar o tema da judicialização da saúde, mais especificamente do deferimento de tutelas de urgência; o uso da medicina baseada em evidências como alternativa para arrefecimento dessa crise institucional; e fomentar o debate em torno de propostas viáveis para minimizar os impactos deletérios da judicialização sobre a gestão do sistema de saúde. (AU).

This essay aims to address the issue of judicialization of health, more specifically the granting of emergency relief; the use of evidence-based medicine as an alternative to alleviate this institutional crisis; and foster debate around viable proposals to minimize the deleterious impacts of judicialization on health system management. (AU).

Este ensayo tiene como objetivo abordar el tema de la judicialización de la salud, más específicamente la concesión de ayuda de emergencia; el uso de medicina basada en evidencia como una alternativa para aliviar esta crisis institucional; y fomentar el debate sobre propuestas viables para minimizar los efectos nocivos de la judicialización en la gestión del sistema de salud. (AU).

Reducing rural maternal mortality and the equity gap in northern Nigeria: the public health evidence for the Community Communication Emergency Referral strategy.

The Sustainable Development Goal (SDG) maternal mortality target risks being underachieved like its Millennium Development Goal (MDG) predecessor. The MDG skilled birth attendant (SBA) strategy proved inadequate to end preventable maternal deaths for the millions of rural women living in resource-constrained settings. This equity gap has been successfully addressed by integrating a community-based emergency obstetric care strategy into the intrapartum care SBA delivery strategy in a large scale, northern Nigerian health systems strengthening project. The Community Communication Emergency Referral (CCER) strategy catalyzes community capacity for timely evacuations to emergency obstetric care facilities instead of promoting SBA deliveries in environments where SBA availability and accessibility will remain inadequate for the near and medium term. Community Communication is an innovative, efficient, equitable, and culturally appropriate community mobilization approach that empowers low- and nonliterate community members to become the communicators. For the CCER strategy, this community mobilization approach was used to establish and maintain emergency maternal care support structures. Public health evidence demonstrates the success of integrating the CCER strategy into the SBA strategy and the practicability of this combined strategy at scale. In intervention sites, the maternal mortality ratio reduced by 16.8% from extremely high levels within 4 years. Significantly, the CCER strategy contributed to saving one-third of the lives saved in the project sites, thereby maximizing the effectiveness of the SBAs and upgraded emergency obstetric care facilities. Pre- and postimplementation Knowledge, Attitude, and Practice Survey results and qualitative assessments support the CCER theory of change. This theory of change rests on a set of implementation steps that rely on three innovative components: Community Communication, Rapid Imitation Practice, and CCER support structures. Innovative communication body tools and the rote learning Rapid Imitation Practice training methodology enabled low-literate volunteers to saturate their communities with informed group discussions transferring communication capacity and ownership to the discussion participants. CCER is especially efficient because virtually every timely, community referral for emergency maternal care results in a saved life, whereas on average, only one in every eight births delivered by an SBA (12%) is expected to be a delivery-associated complication requiring lifesaving care.

The development and validation of a meta-tool for quality appraisal of public health evidence: Meta Quality Appraisal Tool (MetaQAT).

OBJECTIVES: Most quality appraisal tools were developed for clinical medicine and tend to be study-specific with a strong emphasis on risk of bias. In order to be more relevant to public health, an appropriate quality appraisal tool needs to be less reliant on the evidence hierarchy and consider practice applicability. Given the broad range of study designs used in public health, the objective of this study was to develop and validate a meta-tool that combines public health-focused principles of appraisal coupled with a set of design-specific companion tools. STUDY DESIGN: Several design methods were used to develop and validate the tool including literature review, synthesis, and validation with a reference standard. METHODS: A search of critical appraisal tools relevant to public health was conducted; core concepts were collated. The resulting framework was piloted during three feedback sessions with public health practitioners. Following subsequent revisions, the final meta-tool, the Meta Quality Appraisal Tool (MetaQAT), was then validated through a content analysis of appraisals conducted by two groups of experienced public health researchers (MetaQAT vs generic appraisal form). RESULTS: The MetaQAT framework consists of four domains: relevancy, reliability, validity, and applicability. In addition, a companion tool was assembled from existing critical appraisal tools to provide study design-specific guidance on validity appraisal. Content analysis showed similar methodological and generalizability concerns were raised by both groups; however, the MetaQAT appraisers commented more extensively on applicability to public health practice. CONCLUSIONS: Critical appraisal tools designed for clinical medicine have limitations for use in the context of public health. The meta-tool structure of the MetaQAT allows for rigorous appraisal, while allowing users to simultaneously appraise the multitude of study designs relevant to public health research and assess non-standard domains, such as applicability.

Effectiveness of health promotion and public health interventions: lessons from Latin American cases / Efectividad de intervenciones en promoción de la salud y salud pública: Lecciones de casos latinoamericanos

The issue of evidence of effectiveness in public health and health promotion has occupied the attention of academics, technicians, and politicians who recognize not only its importance but the challenges that researchers must confront to obtain reliable and useful information to base public policy decisions and investment of resources. Despite the emergence of Latin American initiatives aimed at building the capacity to obtain such evidence of effectiveness, the practice is still incipient in the region and there are few relevant publications. This article is presented as a contribution and stimulus to further motivate the ongoing search for information and knowledge, concerning the relevance and scope of the practice of public health and health promotion to address adverse health conditions. For this purpose, a review of the literature was carried out, along with the compilation, documentation, and analysis of various cases of Latin American evaluations. From the product of this analysis, proposals are presented for strengthening the theoretical and evaluative practices in Latin America.

El tema de evidencias de efectividad en promoción de la salud y salud pública ha ocupado la atención de académicos, técnicos y políticos, quienes reconocen no sólo su importancia, sino los desafíos que hay que enfrentar para obtener información confiable y útil que fundamente decisiones en política pública e inversión de recursos. Pese a diversas iniciativas latinoamericanas orientadas a la construcción de capacidad para obtener dichas evidencias de efectividad, esta práctica es aún incipiente en la región y son escasas las publicaciones al respecto. Este artículo surge como una contribución y una provocación para motivar la búsqueda permanente de información y conocimiento sobre la pertinencia y alcance de la práctica de la salud pública y la promoción de la salud, la comprensión de los procesos de implementación de las políticas y programas y la valoración de los resultados. Para esto, se ha realizado una revisión de literatura, así como recopilación, documentación y análisis de diversos casos de evaluación latinoamericanos. Como producto del análisis se presentan propuestas para el fortalecimiento de la teoría y la práctica evaluativa en Latinoamérica.