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1.
Comunidad (Barc., Internet) ; 23(1): 0-0, mar.-jun. 2021. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-201952

RESUMO

Buscar el bienestar de la población y la equidad en salud requiere actuar sobre los determinantes sociales de la salud (DSS). El enfoque de salud en todas las políticas es el más idóneo para ello, y la evaluación del impacto en salud, la técnica cada vez más extendida, como instrumento de ayuda en la toma de decisiones. El objetivo principal de este trabajo es hacer un análisis prospectivo del impacto que puede tener el Plan de Movilidad Urbana Sostenible de Almussafes en la salud y equidad en salud de su población. Para ello, se ha empleado la herramienta Fem Salut al nostre municipi? junto con técnicas participativas, poniendo en valor el papel tanto de profesionales y personal técnico municipal como de la propia ciudadanía. A partir del análisis de su discurso, y en base a la evidencia científica, se identificaron los principales impactos del Plan sobre los Determinantes Sociales de la Salud: disminución de la contaminación ambiental y acústica, incremento de los desplazamientos activos y del bienestar emocional, etc. También se recogieron recomendaciones de mejora para potenciar los impactos positivos y su distribución equitativa. La participación ciudadana es un elemento clave en la evaluación de impacto en salud (EIS) de las políticas no sanitarias, y el ámbito local ofrece una oportunidad única para incorporarla en el proceso de toma de decisiones. Con ello, es posible desarrollar políticas públicas saludables y equitativas


Seeking the well-being of the population and health equity requires acting on the social determinants of health. The Health in All Policies approach is the most suitable for this, and Health Impact Assessment is the increasingly widespread technique, as a tool to assist in decision-making. The main objective of this work is to perform a prospective analysis of the impact that the Sustainable Urban Mobility Plan of Almussafes can have on the health and health equity of its population. For this purpose, the tool Fem Salut al nostre municipi? has been used, together with participatory techniques, which highlights the role of both professionals and municipal technical staff, as well as the role of citizens themselves. From the analysis of its discourse, and based on scientific evidence, the most important impacts of the Plan on the social determinants of health were identified: decrease in environmental and noise pollution, increase in active mobility and emotional well-being, among others. Recommendations for improvement to enhance positive impacts and their equitable distribution were also collected. Community participation is a key element in HIA of non-health policies, and the local scope offers a unique opportunity to incorporate this into the decision-making process. With HIA, it is possible to carry out healthy and equitable public policies


Assuntos
Humanos , Avaliação do Impacto na Saúde/métodos , Saúde da População Urbana/normas , Equidade em Saúde , Determinantes Sociais da Saúde , Participação da Comunidade/métodos , Estudos Prospectivos , Colaboração Intersetorial , Identificação Social , Condições Sociais , Relações Interpessoais
5.
PLoS One ; 16(3): e0247474, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33711024

RESUMO

BACKGROUND: Due to low care utilization, a complex intervention was done for two years to optimize the Ethiopian Health Extension Program. Improved quality of the integrated community case management services was an intermediate outcome of this intervention through community education and mobilization, capacity building of health workers, and strengthening of district ownership and accountability of sick child services. We evaluated the association between the intervention and the health extension workers' ability to correctly classify common childhood illnesses in four regions of Ethiopia. METHODS: Baseline and endline assessments were done in 2016 and 2018 in intervention and comparison areas in four regions of Ethiopia. Ill children aged 2 to 59 months were mobilized to visit health posts for an assessment that was followed by re-examination. We analyzed sensitivity, specificity, and difference-in-difference of correct classification with multilevel mixed logistic regression in intervention and comparison areas at baseline and endline. RESULTS: Health extensions workers' consultations with ill children were observed in intervention (n = 710) and comparison areas (n = 615). At baseline, re-examination of the children showed that in intervention areas, health extension workers' sensitivity for fever or malaria was 54%, 68% for respiratory infections, 90% for diarrheal diseases, and 34% for malnutrition. At endline, it was 40% for fever or malaria, 49% for respiratory infections, 85% for diarrheal diseases, and 48% for malnutrition. Specificity was higher (89-100%) for all childhood illnesses. Difference-in-differences was 6% for correct classification of fever or malaria [aOR = 1.45 95% CI: 0.81-2.60], 4% for respiratory tract infection [aOR = 1.49 95% CI: 0.81-2.74], and 5% for diarrheal diseases [aOR = 1.74 95% CI: 0.77-3.92]. CONCLUSION: This study revealed that the Optimization of Health Extension Program intervention, which included training, supportive supervision, and performance reviews of health extension workers, was not associated with an improved classification of childhood illnesses by these Ethiopian primary health care workers. TRIAL REGISTRATION: ISRCTN12040912, http://www.isrctn.com/ISRCTN12040912.


Assuntos
Doença/classificação , Promoção da Saúde/métodos , Determinação de Necessidades de Cuidados de Saúde/tendências , Administração de Caso/tendências , Serviços de Saúde da Criança/tendências , Pré-Escolar , Agentes Comunitários de Saúde/tendências , Participação da Comunidade/métodos , Etiópia/epidemiologia , Feminino , Mão de Obra em Saúde/tendências , Humanos , Lactente , Masculino , Atenção Primária à Saúde/tendências
6.
JMIR Public Health Surveill ; 7(2): e25037, 2021 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-33591284

RESUMO

BACKGROUND: Personas, based on customer or population data, are widely used to inform design decisions in the commercial sector. The variety of methods available means that personas can be produced from projects of different types and scale. OBJECTIVE: This study aims to experiment with the use of personas that bring together data from a survey, household air measurements and electricity usage sensors, and an interview within a research and innovation project, with the aim of supporting eHealth and eWell-being product, process, and service development through broadening the engagement with and understanding of the data about the local community. METHODS: The project participants were social housing residents (adults only) living in central Cornwall, a rural unitary authority in the United Kingdom. A total of 329 households were recruited between September 2017 and November 2018, with 235 (71.4%) providing complete baseline survey data on demographics, socioeconomic position, household composition, home environment, technology ownership, pet ownership, smoking, social cohesion, volunteering, caring, mental well-being, physical and mental health-related quality of life, and activity. K-prototype cluster analysis was used to identify 8 clusters among the baseline survey responses. The sensor and interview data were subsequently analyzed by cluster and the insights from all 3 data sources were brought together to produce the personas, known as the Smartline Archetypes. RESULTS: The Smartline Archetypes proved to be an engaging way of presenting data, accessible to a broader group of stakeholders than those who accessed the raw anonymized data, thereby providing a vehicle for greater research engagement, innovation, and impact. CONCLUSIONS: Through the adoption of a tool widely used in practice, research projects could generate greater policy and practical impact, while also becoming more transparent and open to the public.


Assuntos
Participação da Comunidade/métodos , Difusão de Inovações , Habitação/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adulto , Idoso , Telefone Celular , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Rede Social , Inquéritos e Questionários , Reino Unido , Design Centrado no Usuário
7.
Health Secur ; 19(1): 13-20, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33497272

RESUMO

Risk communication and community engagement are critical elements of epidemic response. Despite progress made in this area, few examples of regional feedback mechanisms in Africa provide information on community concerns and perceptions in real time. To enable humanitarian responders to move beyond disseminating messages, work in partnership with communities, listen to their ideas, identify community-led solutions, and support implementation of solutions systems need to be in place for documenting, analyzing, and acting on community feedback. This article describes how the International Federation of Red Cross and Red Crescent Societies and its national societies in sub-Saharan Africa have worked to establish and strengthen systems to ensure local intelligence and community insights inform operational decision making. As part of the COVID-19 response, a system was set up to collect, compile, and analyze unstructured community feedback from across the region. We describe how this system was set up based on a system piloted in the response to Ebola in the Democratic Republic of the Congo, which tools were adapted and shared across the region, and how the information gathered was used to shape and adapt the response of the Red Cross and Red Crescent Societies and the broader humanitarian response.


Assuntos
COVID-19 , Participação da Comunidade/métodos , Retroalimentação , Cruz Vermelha , África ao Sul do Saara , Comunicação , Tomada de Decisões Gerenciais , Doença pelo Vírus Ebola/prevenção & controle , Humanos , SARS-CoV-2
8.
Am J Med Qual ; 36(1): 17-21, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32911956

RESUMO

The authors developed a process to produce a reliably fitting face mask from materials that were immediately available to health care workers, to reduce the risk of infection. Multiple materials and designs were developed to produce face masks that focused on ease of production, the ability to generate a reliable facial seal, and the ability to tailor the mask for those who did not fit commercially available N95 masks. Two final designs were selected. Mask components were assembled into kits and distributed to community sewists. Plan-Do-Study-Act cycles were developed for quality improvement. A process was successfully developed to produce 5000 face masks in a period of 3 weeks that fit almost all (95%) health care workers who did not fit in a commercially available mask. The process was able to produce quality face masks with specific attention paid to developing masks that would pass qualitative fit testing.


Assuntos
COVID-19/prevenção & controle , Participação da Comunidade/métodos , Máscaras/provisão & distribuição , Humanos , Máscaras/normas
10.
Healthc (Amst) ; 9(1): 100495, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33285500

RESUMO

The United States currently has one of the highest numbers of cumulative COVID-19 cases globally, and Latino and Black communities have been disproportionately affected. Understanding the community-level factors that contribute to disparities in COVID-19 case and death rates is critical to developing public health and policy strategies. We performed a cross-sectional analysis of U.S. counties and found that a 10% point increase in the Black population was associated with 324.7 additional COVID-19 cases per 100,000 population and 14.5 additional COVID-19 deaths per 100,000. In addition, we found that a 10% point increase in the Latino population was associated with 293.5 additional COVID-19 cases per 100,000 and 7.6 additional COVID-19 deaths per 100,000. Independent predictors of higher COVID-19 case rates included average household size, the share of individuals with less than a high school diploma, and the percentage of foreign-born non-citizens. In addition, average household size, the share of individuals with less than a high school diploma, and the proportion of workers that commute using public transportation independently predicted higher COVID-19 death rates within a community. After adjustment for these variables, the association between the Latino population and COVID-19 cases and deaths was attenuated while the association between the Black population and COVID-19 cases and deaths largely persisted. Policy efforts must seek to address the drivers identified in this study in order to mitigate disparities in COVID-19 cases and deaths across minority communities.


Assuntos
COVID-19/diagnóstico , Participação da Comunidade/métodos , Grupos de Populações Continentais/estatística & dados numéricos , Mortalidade/etnologia , COVID-19/epidemiologia , COVID-19/mortalidade , Participação da Comunidade/estatística & dados numéricos , Grupos de Populações Continentais/etnologia , Estudos Transversais , Humanos , Mortalidade/tendências , Estados Unidos/epidemiologia , Estados Unidos/etnologia
11.
J Nutr Educ Behav ; 53(1): 75-78, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33187874

RESUMO

Brighter Bites is a school-based health promotion program that delivers fresh produce and nutrition education to low-income children and their families across 6 locations in the US. This article provides a perspective on how, despite coronavirus disease 2019-related school closures, Brighter Bites pivoted rapidly to collaborate with medical and public health institutions to improve health and food literacy among their families. Through these partnerships, Brighter Bites was able to rapidly provide accurate, evidence-based information related to coronavirus disease 2019 and other social needs, including food, housing, transportation, and access to health care, to help fill a needed gap in vulnerable communities.


Assuntos
COVID-19/prevenção & controle , Assistência Alimentar , Educação em Saúde/métodos , Letramento em Saúde/métodos , Promoção da Saúde/métodos , Serviços de Saúde Escolar , Participação da Comunidade/métodos , Frutas , Humanos , Pobreza , SARS-CoV-2 , Estados Unidos , Verduras
12.
Healthc Q ; 23(3): 15-23, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33243361

RESUMO

The East Toronto Health Partners (ETHP) include more than 50 organizations working collaboratively to create an integrated system of care in the east end of Toronto. This existing partnership proved invaluable as a platform for a rapid, coordinated local response to the COVID-19 pandemic. Months after the first wave of the pandemic began, with the daily numbers of COVID-19 cases finally starting to decline, leaders from ETHP provided preliminary reflections on two critical questions: (1) How were existing integration efforts leveraged to mobilize a response during the COVID-19 crisis? and (2) How can the response to the initial wave of COVID-19 be leveraged to further accelerate integration and better address subsequent waves and system improvements once the pandemic abates?


Assuntos
COVID-19/terapia , Participação da Comunidade , Prestação Integrada de Cuidados de Saúde/organização & administração , Atenção à Saúde/organização & administração , Política de Saúde , COVID-19/epidemiologia , COVID-19/mortalidade , Participação da Comunidade/métodos , Tomada de Decisões Gerenciais , Atenção à Saúde/métodos , Prestação Integrada de Cuidados de Saúde/métodos , Saúde Global , Humanos , Ontário , Inovação Organizacional , Atenção Primária à Saúde/organização & administração , Administração em Saúde Pública/métodos , Alocação de Recursos/métodos , Alocação de Recursos/organização & administração
13.
Healthc Q ; 23(3): 29-33, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33243363

RESUMO

Recent data from across the globe show that COVID-19 is disproportionately affecting those who are already adversely impacted by social determinants of health. In this paper, we explore how members of the Alliance for Healthier Communities - comprehensive, salary-based primary care organizations in Ontario - anticipated the same and rapidly responded by adapting their services to ensure continued equitable access to primary care services. Lessons from this project could be adapted in other primary care team-based models or partnerships to ensure ongoing support for populations that are most at risk from COVID-19 and the consequences of restricted access to services.


Assuntos
COVID-19/terapia , Equidade em Saúde , Atenção Primária à Saúde/organização & administração , COVID-19/epidemiologia , Participação da Comunidade/métodos , Equidade em Saúde/organização & administração , Promoção da Saúde/métodos , Promoção da Saúde/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Humanos , Determinação de Necessidades de Cuidados de Saúde , Ontário , Atenção Primária à Saúde/métodos , Análise de Sistemas
14.
BMC Geriatr ; 20(1): 380, 2020 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008403

RESUMO

BACKGROUND: In the context of worldwide public health, it is very important to promote physical activity among the older people. This study explored the roles and attitudes of senior leaders in promoting group-based exercise in their local communities, specifically to determine the level and extent to which to elderly participation was encouraged. METHODS: This study conducted semi-structured face-to-face in-depth interviews and employed a subsequent thematic analysis. Participants included 10 club leaders and five sub-leaders who were working at senior clubs in Fujisawa-city, Kanagawa, Japan, from July to September 2018. RESULTS: Four themes emerged from the interview responses, including "unwavering attitude/conviction in relation to the vision," "leaders must set an example," "a search for balance in delegating responsibilities to members," and "creating and fostering culture and environment of mutual help." Further, each participant outlined several aims, including "achieving healthy longevity for the entire local community," "having older people promote healthy activities among the older people," and "creating a pro-health town." CONCLUSIONS: Findings indicate that policymakers, public health workers, and healthcare providers should recognize the pivotal roles that senior group leaders play in promoting healthy activities for the older people. These efforts should be strongly considered when developing policies and strategies designed to promote overall healthy longevity from a general community perspective.


Assuntos
Participação da Comunidade/métodos , Exercício Físico , Promoção da Saúde/métodos , Liderança , Participação Social , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Envelhecimento/psicologia , Atitude , Exercício Físico/fisiologia , Exercício Físico/psicologia , Feminino , Estilo de Vida Saudável , Humanos , Entrevistas como Assunto , Japão , Masculino , Pesquisa Qualitativa , Características de Residência , Papel (figurativo)
16.
PLoS One ; 15(10): e0240827, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33075111

RESUMO

OBJECTIVE: Community health worker (CHW)-led education is an important strategy to increase awareness and access to breast cancer screening in medically-underserved communities. This study aimed to develop a context-specific, culturally-appropriate training intervention for South Florida CHWs to educate Latinx immigrant farmworkers on breast cancer and early detection. METHODS: A community-based participatory research (CBPR) study, conducted 2017-2019, informed the design of a training curriculum for CHWs and educational dissemination materials. Twenty-two CHWs were trained and knowledge gains were measuring using a one-group pre-and post-test design. Triangulated evaluation consisted of field observations of CHW-client interactions, CHW self-reports, and rapid assessment surveys of community members. RESULTS: A community stakeholder-informed breast cancer training curriculum resulted in significant, sustained breast cancer knowledge gains among CHWs when comparing pre-, post-, and 4-6 month post-training follow-up test scores. Field observations of educational material dissemination, CHW self-reported evaluations, and community rapid assessment surveys at three health fairs demonstrated this was an effective strategy to engage female Latinx farmworkers in breast cancer education. CONCLUSIONS: Community and key stakeholder participation in the development of a breast cancer educational intervention allowed for tailored design priorities around knowledge-based content, comprehensiveness, relevance, appropriateness, and ease of dissemination to community members. This model of participatory CHW training intervention design can enable future train-the-trainer approaches to disseminate and scale-up evidence-based health education interventions.


Assuntos
Neoplasias da Mama/diagnóstico , Pesquisa Participativa Baseada na Comunidade/métodos , Fazendeiros/educação , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviços de Saúde Comunitária/métodos , Agentes Comunitários de Saúde/educação , Participação da Comunidade/métodos , Participação da Comunidade/psicologia , Currículo , Detecção Precoce de Câncer/métodos , Feminino , Florida , Educação em Saúde , Hispano-Americanos , Humanos , Pessoa de Meia-Idade , Participação dos Interessados
17.
Comunidad (Barc., Internet) ; 22(2): 0-0, jul.-oct. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193596

RESUMO

La soledad y el apoyo social deficiente están reconocidos como predictores de morbimortalidad. Cuando una persona mayor vive sola y no recibe soporte familiar ni social para corregir desviaciones en su autocuidado, se produce una sobreutilización de servicios sanitarios y, posiblemente, un aumento de los ingresos hospitalarios. En 2018, el Consell de Salut del Centro de Salud (CS) República Argentina de Valencia realizó un estudio piloto de detección y abordaje de soledad no deseada en las personas del barrio en el que se estableció que un 45% de las personas que vivían solas y eran mayores de 75 años tendrían un posible diagnóstico de aislamiento social. OBJETIVOS: implementar una red comunitaria de voluntariado de acompañamiento-vigilancia en autocuidados para personas mayores con aislamiento social en el área del CS República Argentina, con el soporte del «Programa de acompañamiento en salud constante» (PASC) de la Cruz Roja, en colaboración con el centro de salud, y estudiar la relación entre soledad y salud. MÉTODOS: mediante un diseño escalado de detección y diagnóstico de aislamiento social, con la participación de técnicos de la Cruz Roja, profesionales del centro de salud y la colaboración de voluntariado de acompañamiento a personas mayores participantes. RESULTADOS: en 7 meses 1.200 personas fueron sensibilizadas de forma directa sobre la soledad y 49 voluntarios del barrio desarrollaron labores de acompañamiento y asistencia a talleres formativos y lúdicos. Los profesionales sanitarios analizaron 216 casos: 149 (69%) no se sintieron solos y 67 (31%) fueron diagnosticados de aislamiento social (código correspondiente a V64.01 según CIE-9). Participaron en el proyecto 54 personas (25%). Existe asociación entre la escala de detección de la soledad existencial (EDSOL) y la participación en el proyecto. La sensación de soledad no deseada presenta correlación positiva con problemas de movilidad, cronicidad y una tendencia de asociación con otras variables de salud (consumo elevado de fármacos, percepción negativa de calidad de vida, etc.). CONCLUSIONES: las intervenciones comunitarias promovidas desde el centro de salud sobre personas que viven solas contribuyen al abordaje del aislamiento no deseado y a su vez generan un barrio más solidario


Loneliness and poor social support are widely recognized as predictors of morbidity and mortality. When an elderly person lives alone and does not receive family or social support to correct minor deviations in basic self-care processes, this leads to overuse of health services and possibly, increased hospital admissions. In 2018, the Consell de Salut of the República Argentina Primary Health Centre in Valencia, began a pilot study to detect and tackle unwanted loneliness in people from the neighbourhood, in which it was established that 45% of people aged over 75 years old who lived alone may be diagnosed with social isolation. OBJECTIVES: To establish a community network of accompanying-surveillance volunteers in self-care for socially isolated elderly people in the area of the República Argentina Primary Care Centre with the support of the Red Cross Constant Health Accompaniment Programme. The specific objective is to study the relationship between loneliness and health. METHODS: Using a scaled design for the detection and diagnosis of social isolation, with the participation of the Red Cross technicians, professionals from the health center, and the collaboration of volunteer support for elderly participants. RESULTS: Over seven months a total of 1200 people have been directly made aware about loneliness and 49 volunteers from the neighbourhood performed accompaniment work and attended training and recreational workshops. Health professionals analyzed 216 cases, of which 149 (69%) did not feel alone and the remaining 67 (31%) were diagnosed with social isolation (code V64.01 according to ICD-9). A total of 54 (25%) agreed to take part in the project. An association was observed between the scale for detection of existential loneliness (EDSOL) and participation in the project. The feeling of unwanted loneliness correlates positively with mobility problems, chronicity and a tendency of association with other health variables such as high consumption of drugs and negative perception of quality of life. CONCLUSIONS: Community interventions promoted by the Primary Health Centre on people who live alone contribute to tackling unwanted isolation, which at the same time generates a more supportive neighbourhood


Assuntos
Humanos , Masculino , Feminino , Idoso , Participação da Comunidade/métodos , Redes Comunitárias , Idoso Fragilizado/psicologia , Programas Voluntários , Agências Voluntárias , Solidão , Argentina , Qualidade de Vida
18.
Am J Public Health ; 110(11): 1678-1686, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32941065

RESUMO

The US public health community has demonstrated increasing awareness of rural health disparities in the past several years. Although current interest is high, the topic is not new, and some of the earliest public health literature includes reports on infectious disease and sanitation in rural places. Continuing through the first third of the 20th century, dozens of articles documented rural disparities in infant and maternal mortality, sanitation and water safety, health care access, and among Black, Indigenous, and People of Color communities. Current rural research reveals similar challenges, and strategies suggested for addressing rural-urban health disparities 100 years ago resonate today. This article examines rural public health literature from a century ago and its connections to contemporary rural health disparities. We describe parallels between current and historical rural public health challenges and discuss how strategies proposed in the early 20th century may inform current policy and practice. As we explore the new frontier of rural public health, it is critical to consider enduring rural challenges and how to ensure that proposed solutions translate into actual health improvements. (Am J Public Health. 2020;110:1678-1686. https://doi.org/10.2105/AJPH.2020.305868).


Assuntos
Saúde Pública/história , Saúde da População Rural/história , Saúde da Criança/história , Doenças Transmissíveis/epidemiologia , Participação da Comunidade/história , Participação da Comunidade/métodos , Grupos de Populações Continentais , Planejamento em Saúde/história , Planejamento em Saúde/organização & administração , Acesso aos Serviços de Saúde/história , Acesso aos Serviços de Saúde/organização & administração , Disparidades nos Níveis de Saúde , História do Século XX , Humanos , Saúde Materna/história , Enfermeiras de Saúde Pública/história , Enfermeiras de Saúde Pública/organização & administração , Política
19.
PLoS One ; 15(9): e0239276, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941520

RESUMO

Good Participatory Practice (GPP) guidelines support and direct community engagement practices in biomedical HIV prevention trials, however no standardized metrics define the implementation and evaluation of these practices. Collaboratively, the Community Program staff of the HIV Vaccine Trials Network (HVTN) and the HIV Prevention Trials Network (HPTN) created a metric to describe, monitor, and evaluate one component of GPP, recruitment practices, in two HIV monoclonal Antibody Mediated Prevention (AMP) clinical trials, HVTN 703/HPTN 081 and HVTN 704/HPTN 085. Through consultation with community representatives from each clinical research site (hereafter "site(s)"), who made up the study Community Working Groups, recruitment strategy descriptors were developed for both trials to characterize responses to "How did you hear about the AMP study?" The Community Working Groups also helped to define and establish time points that were selected to allow comparisons across sites. Data were collected by 43 of 46 clinical research sites from January 1, 2017 to February 28, 2018. All 43 sites used multiple recruitment strategies successfully, but strategies varied by region. Globally, referrals was the most efficient and effective recruitment strategy as evidenced by the screening: enrollment ratio of 2.2:1 in Africa, and 2.1:1 in the Americas/Switzerland. Print materials were also valuable globally (3:1 Africa, 4.2:1 Americas/Switzerland). In Africa, in-person outreach was also quite effective (2.3:1) and led to the most enrollments (748 of 1186, 63%). In the Americas/Switzerland, outreach was also effective (2.6:1), but internet use resulted in the most screens (1893 of 4275, 44%) and enrollments (677 of 1531, 44%), compared to 12 of 2887 (0.4%) and 2 of 1204 (0.1%) in Africa, respectively. Standardized metrics and data collection aid meaningful comparisons of optimal community engagement methods for trial enrollment. Internet strategies had better success in the Americas/Switzerland than in sub-Saharan African countries. Data are essential in outreach staff efforts to improve screening-to-enrollment ratios. Because the effectiveness of recruitment strategies varies by region, it is critical that clinical research sites tailor community engagement and recruitment strategies to their local environment, and that they are supported with resources enabling use of a range of approaches.


Assuntos
Ensaios Clínicos como Assunto , Participação da Comunidade/métodos , Características Culturais , Infecções por HIV/prevenção & controle , Participação dos Interessados , África ao Sul do Saara , América , Educação em Saúde/métodos , Humanos , Seleção de Pacientes , Seleção de Pessoal/métodos , Suíça , Vacinação/métodos
20.
PLoS Negl Trop Dis ; 14(9): e0008499, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32936792

RESUMO

Since the prioritization of Lymphatic Filariasis (LF) elimination in 1997, progress has been made in reducing disease transmission and burden. Validation of elimination through Transmission Assessment Surveys (TAS) in implementation units (IUs) that have received at least 5 rounds of mass drug administration (MDA) and achieved minimum threshold of 65% treatment coverage is required. There are IUs that do not qualify for TAS due to achievement of low treatment coverage. This study sought to identify barriers of community participation and access to MDA, develop and test strategies to be recommended for improved uptake. Two wards in Kaloleni sub-county, Kilifi county with an average treatment coverage of 56% in 2015, 50.5% in 2016 were purposively sampled and a quasi-experimental study conducted. Through systematic random sampling, 350 (pre-intervention) and 338 (post-intervention) household heads were selected and interviewed for quantitative data. For qualitative data, 16 Focus Group Discussions (FGDs) with purposively selected community groups were conducted. Participatory meetings were held with county stakeholders to agree on strategies for improved community participation in MDA. The quantitative data were analyzed using STATA version 14.1, statistical significance assessed by chi square test and qualitative data by QSR NVIVO version 10. The identified strategies were tested in experimental sites during the 2018 MDA and the usual MDA strategies applied in control sites. The results showed an increase in community participation and access to MDA in both sites 80.6% (pre-intervention), 82.9% (post-intervention). The proportion of participants who considered the treatment as necessary significantly (p = 0.001) increased to 96.2% from 88.3% and significantly dropped for those with drug swallowing problems associated with: size (p<0.001), number (p<0.027) and taste (p = 0.001). The implemented strategies may have contributed to increased participation and access to MDA and should be applied for improved treatment uptake. Health education on disease aetiology and importance of drug uptake in all rounds is key to program's success.


Assuntos
Participação da Comunidade/métodos , Filariose Linfática/tratamento farmacológico , Educação em Saúde , Administração Massiva de Medicamentos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição , Filariose Linfática/prevenção & controle , Características da Família , Feminino , Filaricidas/uso terapêutico , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Quênia , Masculino , Pessoa de Meia-Idade
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