One size doesn't fit all: methodological reflections in conducting community-based behavioural science research to tailor COVID-19 vaccination initiatives for public health priority populations.

BACKGROUND: Promoting the uptake of vaccination for infectious diseases such as COVID-19 remains a global challenge, necessitating collaborative efforts between public health units (PHUs) and communities. Applied behavioural science can play a crucial role in supporting PHUs' response by providing insights into human behaviour and informing tailored strategies to enhance vaccination uptake. Community engagement can help broaden the reach of behavioural science research by involving a more diverse range of populations and ensuring that strategies better represent the needs of specific communities. We developed and applied an approach to conducting community-based behavioural science research with ethnically and socioeconomically diverse populations to guide PHUs in tailoring their strategies to promote COVID-19 vaccination. This paper presents the community engagement methodology and the lessons learned in applying the methodology. METHODS: The community engagement methodology was developed based on integrated knowledge translation (iKT) and community-based participatory research (CBPR) principles. The study involved collaboration with PHUs and local communities in Ontario, Canada to identify priority groups for COVID-19 vaccination, understand factors influencing vaccine uptake and co-design strategies tailored to each community to promote vaccination. Community engagement was conducted across three large urban regions with individuals from Eastern European communities, African, Black, and Caribbean communities and low socioeconomic neighbourhoods. RESULTS: We developed and applied a seven-step methodology for conducting community-based behavioural science research: (1) aligning goals with system-level partners; (2) engaging with PHUs to understand priorities; (3) understanding community strengths and dynamics; (4) building relationships with each community; (5) establishing partnerships (community advisory groups); (6) involving community members in the research process; and (7) feeding back and interpreting research findings. Research partnerships were successfully established with members of prioritized communities, enabling recruitment of participants for theory-informed behavioural science interviews, interpretation of findings, and co-design of targeted recommendations for each PHU to improve COVID-19 vaccination uptake. Lessons learned include the importance of cultural sensitivity and awareness of sociopolitical context in tailoring community engagement, being agile to address the diverse and evolving priorities of PHUs, and building trust to achieve effective community engagement. CONCLUSION: Effective community engagement in behavioural science research can lead to more inclusive and representative research. The community engagement approach developed and applied in this study acknowledges the diversity of communities, recognizes the central role of PHUs, and can help in addressing complex public health challenges.

Promoting Infant Mental Health Through Evidence-Informed Interventions to Support Infant Feeding and the Transition to Parenthood: A Clinical Practice Example.

Infant mental health is influenced by many factors including the successful transition to parenthood and the feeding relationship with caregivers. Region of Peel - Public Health in Ontario, Canada promotes infant mental health through interventions that encourage cue-based feeding and responsive infant care that helps individual families meet their infant feeding goals and build a foundation of responsive parenting. Interventions have been developed to meet the needs of a large, ethnically diverse population. The use of a biodevelopmental framework identifying nutrition and the environment of relationships as important foundations of health provided key areas of focus for Nurturing the Next Generation, a public health strategic priority. Research evidence, literature syntheses, local research, and data informed the interventions. The promotion of a positive nursing practice environment supports the public health nurses who deliver these interventions. This framework of effective public health practice contributes to long-term health outcomes, including the promotion of mental health for infants, their families, and the population.

A realist synthesis of social connectivity interventions during transition to parenthood: The value of relationships.

BACKGROUND: Social connections are important during the transition to parenthood. A wide body of literature suggests that these connections enhance health and contribute to wellbeing. In the case of parents and families, social connections can influence child development. Nurses and public health agencies are in a unique position to advocate for resources and approaches to enhance social connectivity for parents during this important life transition. OBJECTIVES: The aim of this review was to identify the universal social connectivity interventions that work, and the conditions that foster social connections for parents and enhance child development. The review was undertaken as part of a larger research project to inform the question: What are the population-level interventions that public health can implement to promote social, emotional and cognitive development from the prenatal period to the end of the first year of life? Social connectivity is one of three domains that were explored in the full study. DESIGN: Realist synthesis. DATA SOURCES: Medline, CINAHL, ERIC, SocAbs, PsychINFO, grey literature. REVIEW METHODS: A literature search was conducted using relevant key words and MeSH headings. Nearly 2000 papers were reviewed by title and sorted based on inclusion and exclusion criteria. Data extraction aided quality appraisal and analysis and informed the development of an explanatory mechanism. RESULTS: Twenty-seven papers were included in the synthesis, with findings described in four theme areas: (a) connections in the community, (b) internet connections, (c) prenatal connections, and (d) connections for fathers. The literature available to answer the research question is scant and of varying quality. Community development, family-systems intervention practices, principles of father inclusive practice and group prenatal care models have been demonstrated to foster social connectivity for parents. Online social networking provides valuable informational support. CONCLUSIONS: Changing social structures and technology have influenced the way in which new parents access support. Social connections fostered in the parenting environment have the potential to enhance wellbeing for parents and thus contribute to children's positive development. Nurses are in a position to advocate for the use of evidence-informed approaches when planning programs and services for parents.

Parent education interventions designed to support the transition to parenthood: A realist review.

BACKGROUND: Public health nurses use parent education programmes to support individuals' transition to parenthood. A wide array of these programmes exists; however, the approach must be accommodated by resources available in a publicly funded system. For example, some new-parent education approaches use 1:1 home visiting (with a nurse or trained lay-home visitor) but the costs of this intensive approach can be prohibitive. Because of this limitation there is an interest in identifying effective and efficient new parent educational approaches that can realistically be provided at a universal level. Unfortunately, there is a lack of high-quality evaluation identifying programmes or educational processes that meet these criteria. OBJECTIVES: To identify potentially effective new-parenting education interventions that could be implemented at a population level during the transition to parenthood period. DESIGN: Realist synthesis. DATA SOURCES: Medline, CINAHL, ERIC, PsycINFO, Sociological Abstracts, grey literature. REVIEW METHODS: A realist review method generated a total of 72 papers that were used to inform the results. A three-pronged approach was used incorporating an initial search (6), a database search using applicable keywords and MeSH headings (58), and review of literature identified by advisory group (8 grey literature). An 'implementation chain' was developed to outline the overall logic and process behind parent education interventions and to guide the analysis. RESULTS: Seventy-two papers informed this review: 13 systematic reviews/meta-analyses, 34 intervention studies, 9 opinion papers, 8 programme reviews, and 8 grey literature reports. There was no compelling evidence to suggest that a single educational programme or delivery format was effective at a universal level. Some inherent issues were identified. For example, adult learning principles were overlooked and theories of parent-child interaction were not in evidence. No direct links between universal new-parent education programmes and child development outcomes were established. Programme reach and attrition were key challenges. Programme evaluation criteria were inconsistent, with an over-reliance on parent satisfaction or self-reported intention to change behaviour. There was evidence that effective facilitators helped increase parents' perceived satisfaction with programmes. CONCLUSIONS: It is unlikely that a single standardized format or programme will meet all the specific learning needs of parents. Multiple approaches that will allow people to access information or education at a time and in a format that suits them may be of value. The importance of the transition to parenthood and its impact on parent and child wellbeing warrant careful consideration of current programming and careful evaluation of future initiatives.