Community engagement in the prevention and control of COVID-19: Insights from Vietnam.

INTRODUCTION: Community engagement (CE) is an effective public health strategy for improving health outcomes. There is limited published knowledge about effective approaches to CE in ensuring effective responses to COVID-19 throughout lockdowns, travel restrictions and social distancing. In this paper, we contribute to bridging this gap by highlighting experience of CE in Vietnam, specifically focusing on migrant workers in Vietnam. METHODS: A cross-sectional qualitative study design was used with qualitative data collection was carried out during August-October 2020. Two districts were purposefully selected from two large industrial zones. Data was collected using in-depth interviews (n = 36) with individuals and households, migrants and owners of dormitories, industrial zone factory representatives, community representatives and health authorities. Data was analyzed using thematic analysis approach. The study received ethics approval from the Hanoi University Institutional Review Board. RESULTS: The government's response to COVID-19 was spearheaded by the multi-sectoral National Steering Committee for the Prevention and Control of COVID-19, chaired by the Vice Prime Minister and comprised different members from 23 ministries. This structure was replicated throughout the province and local levels and all public and private organizations. Different activities were carried out by local communities, following four key principles of infection control: early detection, isolation, quarantine and hospitalization. We found three key determinants of engagement of migrant workers with COVID-19 prevention and control: availability of resources, appropriate capacity strengthening, transparent and continuous communication and a sense of trust in government legitimacy. DISCUSSION AND CONCLUSION: Our results support the current literature on CE in infection control which highlights the importance of context and suggests that future CE should consider five key components: multi-sectoral collaboration with a whole-of-community approach to strengthen governance structures with context-specific partnerships; mobilization of resources and decentralization of decision making to encourage self-reliance and building of local capacity; capacity building through training and supervision to local institutions; transparent and clear communication of health risks and sensitization of local communities to improve compliance and foster trust in the government measures; and understanding the urgent needs ensuring of social security and engaging all parts of the community, specifically the vulnerable groups.

Levels of Employment and Community Engagement among Low-Income Adults: Implications for Medicaid Work Requirements.

CONTEXT: Twenty states are pursuing community engagement requirements ("work requirements") in Medicaid, though legal challenges are ongoing. While most nondisabled low-income individuals work, it is less clear how many engage in the required number of hours of qualifying community engagement activities and what heterogeneity may exist by race/ethnicity, age, and gender. The authors' objective was to estimate current levels of employment and other community engagement activities among potential Medicaid beneficiaries. METHODS: The authors analyzed the US Census Bureau's national time-use survey data for the years 2015 through 2018. Their main sample consisted of nondisabled adults between 19 and 64 years with family incomes less than 138% of the federal poverty level (N = 2,551). FINDINGS: Nationally, low-income adults who might become subject to Medicaid work requirements already spent an average of 30 hours per week on community engagement activities. However, 22% of the low-income population-particularly women, older adults, and those with less education-would not currently satisfy a 20-hour-per-week requirement. CONCLUSIONS: Although the majority of potential Medicaid beneficiaries already meet community engagement requirements or are exempt, 22% would not currently satisfy a 20-hour-per-week requirement and therefore could be at risk for losing coverage.

Changes in Sugary Beverage Consumption and Public Perceptions in Upstate New York After Implementation of a Community Awareness Campaign and Healthier Vending Strategies.

OBJECTIVE: We evaluated the impact of a community-based healthy beverage procurement and serving practices program, and educational media campaign, on residents' behaviors and beliefs regarding sugary beverages. DESIGN: Repeated cross-sectional population surveys in 2013 and 2014 were conducted, as well as semistructured interviews with key informants. We employed multivariate differences-in-differences regression analysis, adjusting for demographics and weight status, using the survey data. Key informant interviews were reviewed for common themes. SETTING: Three rural counties in upstate New York with high prevalence of children living in poverty and childhood obesity. PARTICIPANTS: Residents of Broome, Cattaraugus, and Chautauqua, with Chemung as a control, reached through cross-sectional random-digit-dial landline and cellular telephones, and practitioners involved in intervention implementation. INTERVENTION: Community organizations were encouraged through presentations to leadership to adopt healthier vending policies, providing more low- and no-sugar options, and were provided assistance with implementation. In addition, a media campaign supported by presentations to the public aimed to educate residents regarding the health consequences of sugary beverage consumption. OUTCOME MEASURES: The survey measured population demographics and sugary beverage consumption frequency, availability, beliefs about harmfulness, and support for regulation, pre- and postintervention. Key informant interviews elicited perceived program challenges and successes. RESULTS: Compared with temporal trends in the control county, availability of regular soda in the intervention counties decreased (differences-in-differences estimator: ß = -.341, P = .04) and support for regulation increased (differences-in-differences estimator: ß = .162, P = .02). However, there were no differences regarding beliefs about harmfulness or consumption. Practitioners confirmed that the intervention increased awareness but was insufficient to spur action. CONCLUSION: Although public education on the harmfulness of sugary beverages and provision of healthier options in some vending machines successfully impacted soda availability and support for regulation, it did not reduce consumption. This intervention seems promising but should be paired with other community-based interventions for a more comprehensive approach.

Public Approval of Exception From Informed Consent in Emergency Clinical Trials: A Systematic Review of Community Consultation Surveys.

Importance: The US Food and Drug Administration (FDA) created the exception from informed consent (EFIC) pathway in 1996 to allow some emergency trials to enroll patients without informed consent. To protect individual autonomy and preserve public trust, the FDA requires that EFIC trial investigators consult with community members before a trial may begin. Objectives: To analyze data from surveys conducted as part of community consultation ahead of EFIC trials and assess levels of public approval. Data Sources: All trials granted an EFIC must submit documentation of compliance with EFIC regulations to a publicly available docket at the FDA. Submissions between November 1, 1996, and October 23, 2017, were reviewed. Study Selection: Trials with survey data were included. Data Extraction and Synthesis: Data were extracted between January 2018 and June 2018 and were analyzed between June 2018 and August 2018. The quality and validity of data were assessed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A random-effects metaregression was used to assess the association of demographic characteristics with EFIC approval. Main Outcomes and Measures: The primary study outcome was EFIC approval. Results: The FDA docket contained 15 958 pages of material with survey data for 42 448 individuals submitted by 27 trials. Public approval of EFIC varied by question type, with more people willing to approve initiation of EFIC trials in their community (86.5%) than personal enrollment (73.0%), enrollment of a family member (68.6%), or the principle of enrollment without consent (58.4%) (P < .001 for all comparisons). In the United States, African American individuals made up 29.3% of those enrolled in EFIC trials that reported data on race (5064 of 17 302) but only 16.7% of those surveyed as part of community consultation. In the United States and Canada, men made up 42.9% of the surveyed population but 65.6% of those eventually enrolled in EFIC trials (29 961 of 45 694). Groups surveyed with higher proportions of African American and male respondents had lower rates of EFIC approval. Conclusions and Relevance: Public approval of EFIC trials varied by question type and by the respondents' reported race and sex. The demographic characteristics of those surveyed did not match the demographic characteristics of EFIC enrollees. The FDA could strengthen community consultation by standardizing survey instruments and reporting, requiring broader inclusion of African American and male respondents, clarifying the function of surveys in the development and modification of trial protocols, and building more public consensus around the acceptable use of EFIC.

Pobreza, proteção social e cidadania: uma análise do direito à saúde no Brasil a partir da Constituição Federal de 1988 / Poverty, social protection and citizenship: an analysis of the right to health in Brazil from the Federal Constitution of 1988

O presente artigo teve por escopo analisar o processo de constituição da ideia do direito à saúde enquanto direito social no Brasil, integrante do rol de direitos fundamentais insculpidos na Constituição Federal de 1988. Para tanto realizou-se uma concisairrupção histórica no processo de construção da concepção de proteção social na Europa ocidental. Objetivou-se, ainda, analisar a proteção social enquanto elemento essencial da cidadania. Buscou-se compreender a seguridade social como núcleo do Estado de Bem-Estar e discutir o contexto de inserção da questão do direito à saúde na agenda pública. A presente pesquisa utilizou-se dométodo de pesquisa dedutivo, com a apropriação dos conceitos de proteção social e direitos sociais, refletindo sobre as determinações dos conteúdos presentes na concepção constitucional do direito à saúde.(AU)

The purpose of this article was to analyze the process of constitution of the idea of the right to health as a social right in Brazil, as part of the list of fundamental rights inscribed in the Federal Constitution of 1988. For this purpose, a concise historical irruption was made in the process of conception of social protection in western Europe. The objective was also to analyze social protection as an essential element of citizenship. We sought to understand social security as the core of the welfare state and to discuss the context of insertion of the right to health issue in the public agenda. This research used the deductive research method, with the appropriation of the concepts of social protection and social rights, reflecting on the determinations of the contents present in the constitutional conception of the right to health.(AU)

How Has the Presence of Zimbabwe's Victim-Friendly Court and Relevant Child Protection Policy and Legal Frameworks Affected the Management of Intrafamilial Child Sexual Abuse in Zimbabwe? The Case of Marondera District.

The study intended to assess, based on the perceptions of Victim-Friendly Court (VFC) professionals in Marondera District in Zimbabwe, how the presence of the VFC and relevant child protection policy and legal frameworks has affected the management of Intrafamilial Child Sexual Abuse (ICSA) in Zimbabwe. Sem-istructured questionnaires were administered to 25 professionals from 13 VFC agencies in Marondera, while one-on-one semi-structured interviews were conducted with 15 key informants who included five ICSA survivors and their respective five caregivers as well as five key community child protection committee members. All 40 participants were selected using purposive sampling. Data were analyzed manually using thematic analysis, descriptive analysis, and document analysis. The study showed that the VFC manages ICSA through prevention, protection, treatment, and support interventions, and that its mandate is guided by key child protection policy and legal frameworks, particularly the National Action Plan for Orphaned and Vulnerable Children and the Children's Act (Chapter 5:06). The presence of these mechanisms is perceived to have resulted in increased awareness of ICSA, realization of effective results, increased reporting of ICSA, and enhanced coordination among VFC agencies. However, the same frameworks are perceived to be fraught with gaps and inconsistencies, too prescriptive, incoherent with some key aspects of the National Constitution and international child rights standards, and poorly resourced for effective implementation. All this has negatively affected the management of ICSA. Therefore, the Government of Zimbabwe should consistently review these systems to make them responsive to the ever-evolving factors associated with ICSA. Also, alignment with the National Constitution, full domestication of global child rights instruments, and routine collection of better statistics for evidence-based policy- and decision-making, and for better monitoring of progress and evaluation of outcomes, are necessary for positive results. Non-governmental stakeholders too should chip in with human, technical, and financial resources to enhance effective management of the social problem.

Meaningful participation for children in the Dutch child protection system: A critical analysis of relevant provisions in policy documents.

Policymakers are increasingly focusing on the participation of children in the child protection system (CPS). However, research shows that actual practice still needs to be improved. Embedding children's participation in legislation and policy documents is one important prerequisite for achieving meaningful participation in child protection practice. In this study, the participation of children in the Dutch CPS under the new Youth Act 2015 is critically analyzed. National legislation and policy documents were studied using a model of "meaningful participation" based on article 12 of the UNCRC. Results show that the idea of children's participation is deeply embedded in the current Dutch CPS. However, Dutch policy documents do not fully cover the three dimensions of what is considered to be meaningful participation for children: informing, hearing, and involving. Furthermore, children's participation differs among the organizations included in the child protection chain. A clear overall policy concerning the participation of children in the Dutch CPS is lacking. The conclusions of this critical analysis of policy documents and the framework of meaningful participation presented may provide a basis for the embedding of meaningful participation for children in child protection systems of other countries.

Consumer-Centric Care: Latest Buzzword or New Reality?

With the industry in flux as federal healthcare reform legislation debates continue, leaders are preparing for what the post-Affordable Care Act world might look like. Predictions include patients assuming more responsibility for healthcare costs and therefore behaving like consumers, including choosing providers based on perceived value. What actions should chief nurse executives take to ensure the nursing enterprise responds to rising consumerism in healthcare?

Untangling outcomes of de jure and de facto community-based management of natural resources.

We systematically reviewed the literature on the tragedy of the commons and common-property resources. We segregated studies by legal management regimes (de jure regimes) and management that develops in practice (de facto regimes) to understand how the structure of regime formation affects the outcome of community management on sustainability of resource use. De facto regimes, developed within the community, are more likely to have positive impacts on the resource. However, de facto regimes are fragile and not resilient in the face of increased population pressure and unregulated markets, and de facto management regimes are less successful where physical exclusion of external agents from resources is more difficult. Yet, formalization or imposition of de jure management regimes can have complicated impacts on sustainability. The imposition of de jure regimes usually has a negative outcome when existing de facto regimes operate at larger scales than the imposed de jure regime. In contrast, de jure regimes have largely positive impacts when the de facto regimes operate at scales smaller than the overlying de jure regimes. Formalization may also be counterproductive because of elite capture and the resulting de facto privatization (that allows elites to effectively exclude others) or de facto open access (where the disenfranchised may resort to theft and elites cannot effectively exclude them). This underscores that although the global movement to formalize community-management regimes may address some forms of inequity and may produce better outcomes, it does not ensure resource sustainability and may lead to greater marginalization of users. Comparison of governance systems that differentiate between initiatives that legitimize existing de facto regimes and systems that create new de facto regimes, investigations of new top-down de jure regimes, and studies that further examine different approaches to changing de jure regimes to de facto regimes are avenues for further inquiry.

Population Engagement and Consultation at the Local Level: Thailand Experience.

The World Health Organization handbook on Strategizing National Health in the 21st Century has emphasized the importance of the process of population consultation on needs and expectations. According to Thailand National Health Act 2007, three innovative social tools for participatory healthy public policy process were proposed, i.e., health assembly, health impact assessment and health system statute (charter). In practice, population consultation process is required in the process of the tools implementation. Therefore, this paper aims to illustrate how local health statute implementation supports population participation and consultation at the local level. The first local health statute owned by Cha-lae sub-district in Songkla Province had been introduced in 2009. So far, there are above 500 sub-districts or "Tambon" having their own health system statutes. Tambon Administrative Organization (TAO), health and non-health sectors, community leaders and civil society seemed to be key actors or a mechanism for the local health statute. This demonstrated three crucial elements or sectors for policy development, i.e., policy maker, evidence support and society. Contents of the local health statute are wide ranged, including social determinants, risks and diseases, life style, health services, health fund, to mental and social health in regard to the local problem and context. Therefore, it needs the process of discussion and consultation to seek their common interest and expectation. Local health statute in Thailand is an example of engagement and consultation of the population for health policy. This confirmed the process of population consultation on their needs and expectation that can be implemented both at national and local levels. This is also the strategy to improve the accountability of policy makers for health impacts at all levels of policy making. The challenges of local health statute include the mechanism to maintain and ensure the engagement and ownership for sustainable implementation. Lastly, the local government's continued commitment toward providing funding support through the implementation process and the self-assessment framework of implementation is needed.

Data inconsistencies from states with unconventional oil and gas activity.

The quality and availability of unconventional oil and gas (O&G) data in the United States have never been compared methodically state-to-state. By conducting such an assessment, this study seeks to better understand private and publicly sourced data variability and to identify data availability gaps. We developed an exploratory data-grading tool - Data Accessibility and Usability Index (DAUI) - to guide the review of O&G data quality. Between July and October 2013, we requested, collected, and assessed 5 categories of unconventional O&G data (wells drilled, violations, production, waste, and Class II disposal wells) from 10 states with active drilling activity. We based our assessment on eight data quality parameters (accessibility, usability, point location, completeness, metadata, agency responsiveness, accuracy, and cost). Using the DAUI, two authors graded the 10 states and then averaged their scores. The average score received across all states, data categories, and parameters was 67.1 out of 100, largely insufficient for proper data transparency. By state, Pennsylvania received the highest average ( = 93.5) and ranked first in all but one data category. The lowest scoring state was Texas ( = 44) largely due to its policy of charging for certain data. This article discusses the various reasons for scores received, as well as methodological limitations of the assessment metrics. We argue that the significant variability of unconventional O&G data-and its availability to the public-is a barrier to regulatory and industry transparency. The lack of transparency also impacts public education and broader participation in industry governance. This study supports the need to develop a set of data best management practices (BMPs) for state regulatory agencies and the O&G industry, and suggests potential BMPs for this purpose.