Promoting long-acting reversible contraception among post-abortion clients with a provider-comparison intervention: a cluster randomized controlled trial in Nepal.

BACKGROUND: Although long-acting reversible contraception (LARC) is more effective and longer lasting than short-acting methods, uptake remains low among post-abortion clients. Using a stepped-wedge, cluster-randomized trial, we evaluate the impact of a provider-level peer-comparison intervention to encourage choice of LARC in Nepal among post-abortion clients. METHODS: The intervention used prominently displayed monthly posters comparing the health clinic's previous month performance on LARC uptake against peer clinics. To understand how the intervention affected behavior, while ensuring voluntarism and informed choice, we used mystery client visits, in-depth provider interviews, and client exit survey data. The trial examined 17,680 post-abortion clients in 36 clinics in Nepal from July 2016 to January 2017. The primary outcome was the proportion of clients receiving LARCs. Statistical analysis used ordinary least squares (OLS) regression with ANCOVA estimation to assess the intervention's impact on LARC uptake while controlling for client- and clinic-level characteristics. RESULTS: The intervention increased LARC use among post-abortion clients by 6.6% points [95% CI: 0.85 to 12.3, p-value < 0.05], a 29.5% increase in LARC use compared to control clinics. This effect persisted after the formal experiment ended. Analysis of provider and client experiences showed that the behavioral intervention generated significant change in providers' counseling practices, motivated the sharing of best practices. Quality of care indicators either remained stable or improved. CONCLUSION: We find that a provider-level behavioral intervention increases LARC uptake among post-abortion clients. This type of intervention represents a low-cost option to contribute to reducing unmet need for contraception through provider behavior change.

Health literacy and COVID-19.

In early 2020, the world experienced an unprecedented health crisis. When the pandemic of coronavirus was declared by the World Health Organization, it brought with it sudden and dramatic changes to everyday life. In the UK, the key message from the Government was to 'Stay at home, protect the NHS, save lives', sending out a clear warning that failing to stay at home would put other lives and the ability of the NHS to cope at risk. This editorial discusses COVID-19, how society responded and the vital role that health literacy plays in saving lives during a global health emergency.

Structural Effects on HIV Risk Among Youth: A Multi-level Analysis.

We proposed a multilevel model of structural influences on HIV-risky sexual partnerships in a diverse sample of 1793 youth residing in 23 states and the District of Columbia. We examined the influence of concentrated disadvantage, HIV stigma, and sexual and gender minority stigma on engagement in HIV risky sexual partnerships and whether youth's participation in opportunity structures, anticipation of HIV stigma, and perceptions of their community as youth-supportive settings mediated structural effects. After controlling for age, HIV status, and race, we found structural HIV stigma had deleterious indirect effects on youth's participation in HIV-risky sexual partnerships. Concentrated disadvantage and structural sexual and gender minority stigma had direct negative effects on youth's perceptions of their communities as supportive and on their participation in prosocial activity. Support perceptions had direct, protective effects on avoidance of HIV-risky sexual partnerships. Structural stigma undermines youth's belief that their communities invest in their safety and well-being.

Making information skills meaningful: a case study from occupational therapy.

The effective delivery of information literacy training can be a challenging process, and health library and information professionals are constantly innovating in this area. This article presents a case study of the BHSc (Hons) Occupational therapy degree programme at York St John University to demonstrate ways in which deep integration of information skills into the curriculum can be achieved. The article advises that in the delivery of health and social care related information skills, we should look more broadly at where relevant learning can happen. In particular, contexts of the health care environment are suggested as a consideration rather than the narrow scope of the academic, classroom-based environment. Examples are provided of specific teaching and learning activities used on the programme alongside CPD activity and curriculum design.

Innovation, engagement and development: moving forward in health information settings.

The current trends influencing change in health information and library settings are presenting some exciting new opportunities for health information specialists. Increasingly, knowledge specialists are playing a pivotal role in the effective mobilisation of knowledge and evidence. The focus for our profession will continue to be on demonstrating the value and impact of our services, but a shift in expectations about how those services are delivered will need to be underpinned by new tools and skill sets. These issues are reflected in the themes of the Health Libraries Group 2018 conference, and in conjunction with the event, this virtual issue draws together a collection of articles reflecting those themes. Topics covered in the virtual issue include the following: Toolkits, online systems and emergent technologies to support health information practice; Continuing professional development; Community projects, engagement, outreach and public health; Value and impact and evidence-based practice; Service improvement and library management; and Digital and health literacy. The papers selected for this issue provide some excellent examples of how we, as a profession, are initiating change in creative ways and rising to the exciting challenges of the future.

Structural and Community Change Outcomes of the Connect-to-Protect Coalitions: Trials and Triumphs Securing Adolescent Access to HIV Prevention, Testing, and Medical Care.

Connect to Protect (C2P), a 10-year community mobilization effort, pursued the dual aims of creating communities competent to address youth's HIV-related risks and removing structural barriers to youth health. We used Community Coalition Action Theory (CCAT) to examine the perceived contributions and accomplishments of 14 C2P coalitions. We interviewed 318 key informants, including youth and community leaders, to identify the features of coalitions' context and operation that facilitated and undermined their ability to achieve structural change and build communities' capability to manage their local adolescent HIV epidemic effectively. We coded the interviews using an a priori coding scheme informed by CCAT and scholarship on AIDS-competent communities. We found community mobilization efforts like C2P can contribute to addressing the structural factors that promote HIV-risk among youth and to community development. We describe how coalition leadership, collaborative synergy, capacity building, and local community context influence coalitions' ability to successfully implement HIV-related structural change, demonstrating empirical support for many of CCAT's propositions. We discuss implications for how community mobilization efforts might succeed in laying the foundation for an AIDS-competent community.

Meeting the challenges of clinical information provision.

This virtual issue of the Health Information and Libraries Journal (HILJ) has been compiled to mark the 5th International Clinical Librarian Conference 2011. In considering the challenges of clinical information provision, the content selected for the virtual issue offers an international flavour of clinical information provision and covers a variety of different facets of clinical librarianship. The issue broadly covers the areas of information needs and preferences, clinical librarian roles and services, and education and training, and reflects the way in which a normal issue of the HILJ would be presented. This includes a review article, a collection of original articles, and the three regular features which comprise International Perspectives and Initiatives, Learning and Teaching in Action, and Using Evidence in Practice. All papers included in this virtual issue are available free online.

Online learning: the brave new world of massive open online courses and the role of the health librarian.

In a wired, virtual and information rich society, MOOCs (Massive Open Online Courses) are leading us into a brave new world in which their key role is to support lifelong networked learning. This feature looks at the broad role of MOOCs and considers them within the context of health, and health librarianship. In particular, it provides examples of where health librarians have developed MOOCs and what opportunities there are in the future for health librarians to collaborate in the development and delivery of health MOOCs. H.S.

International collaborations in learning and teaching: perspectives from a visiting professorship.

This article provides a reflection on the outcomes of an international collaboration between health librarians and academics at York St John University and Pacific University Oregon. In particular, it describes how a month-long visiting professorship from an academic with a clinical librarian background at the Faculty of Health and Life Sciences helped to develop and inform teaching practice in the areas of information literacy and evidence-based health practice on health programmes at Pacific University. Perspectives are offered from both institutions on the rich exchange of knowledge and practice that took place during the visit and the ongoing impact it has had on teaching practices. H. S.

Are you a budding academic writer?

Academic writing can seem a daunting prospect although with the right support and information it can be more achievable than you think. In this first set of editorial comments of 2016, editors from all sections of the Health Information and Libraries Journal outline the origins of the individual section of the journal which they oversee and highlight some of the things you might want to consider when thinking of submitting your writing for publication.

Health information, what happens when there isn't any? Information literacy and the challenges for rare and orphan diseases.

This feature looks at the challenges for information literacy in rare and orphan diseases. In particular, it focuses on the information difficulties faced by those living with a rare condition or awaiting a diagnosis, and also those of the health professionals in charge of their care. The feature also highlights some of the key issues that library and information professionals need to be aware of when providing information support in such circumstances.

Cinemeducation: using film as an educational tool in mental health services.

This feature looks at the benefits of using film as an educational tool for mental health. In particular, it presents two case studies outlining how two health library services successfully implemented film clubs for the purposes of teaching and learning for mental health. H.S.

Combating plagiarism: the role of the health librarian.

This feature looks at the issue of plagiarism in health care students and the role of the health librarian in combating the problem. In particular, consideration is given to how plagiarism can occur and provides some examples from two UK universities of approaches health librarians can take in supporting students to avoid these common pitfalls.

"My Family Was Also Happy": Couples' Qualitative Reports of a Combined Behavioral Economics and Cognitive Behavioral Therapy Intervention to Reduce Alcohol Use and Intimate Partner Violence.

Improving intimate partner violence interventions requires understanding pathways to change among couples participating in these interventions. This article presents qualitative data from 18 males and 16 females who participated in a combined behavioral economics (contingency management) and cognitive behavioral therapy alcohol and violence reduction intervention trial in Bengaluru, India. Results confirmed several theorized pathways of change, as well as identified further mechanisms through which the intervention supported the change. These included the emotional impacts of incentives, perceived and actual accountability via breathalyzers and family involvement, and enhanced support gained through counseling skills. Findings reveal critical insights into intervention design for future implementation.

If you cannot beat them, join them! Using Health 2.0 and popular Internet applications to improve information literacy.

The popularity of Health 2.0 technologies has grown exponentially in recent years. They are increasingly being used to inform and support professional practice. This article discusses the use of the health facet of Web 2.0 applications by health professionals. In particular, it considers their value in the delivery of information literacy agendas by health librarians for health professionals.

A Combined Behavioral Economics and Cognitive Behavioral Therapy Intervention to Reduce Alcohol Use and Intimate Partner Violence Among Couples in Bengaluru, India: Results of a Pilot Study.

Hazardous drinking is an important contributing factor to intimate partner violence (IPV) occurrence. However, only a limited number of community-based alcohol reduction interventions have been tested in low- and middle-income countries (LMICs) for their efficacy in reducing IPV. This pilot intervention study tested a 1-month combined behavioral economics and cognitive behavioral therapy intervention to reduce hazardous alcohol use and IPV in Bengaluru, India. Sixty couples were randomized to one of three study arms to test the effect of incentives-only and incentives plus counseling interventions compared with a control condition. Alcohol use among male participants was assessed using breathalyzer tests. Violence experienced by female participants was measured using the Indian Family Violence and Control Scale. Couples in the counseling arm participated in four weekly counseling sessions. Male participants in the incentive arms earned a reward for sobriety (breath alcohol concentration [BrAC] <0.01 g/dl). Results showed that while incentives reduced alcohol use, there was a greater proportion of negative BrAC samples among participants in the counseling arm compared with the control group (0.96 vs. 0.76, p = .03). Violence also decreased in both intervention arms. The estimated mean violence score for the counseling arm was 10.8 points lower than the control arm at 4-month follow-up visit (p = .02). This study contributes important evidence to the field of alcohol reduction and IPV prevention approaches in LMIC settings and adds to the growing evidence that alcohol reduction is a modifiable means of addressing IPV.

Theories of learning: models of good practice for evidence-based information skills teaching.

This feature considers models of teaching and learning and how these can be used to support evidence based practice.

Using Behavioral Science to Design a Peer Comparison Intervention for Postabortion Family Planning in Nepal.

Despite the provision of free and subsidized family planning services and clients' demonstrated intentions to delay pregnancies, family planning uptake among women who receive abortion and postabortion services at Sunaulo Parivar Nepal (SPN), one of Nepal's largest non-governmental sexual and reproductive health (SRH) providers, remains low. Through meetings, interviews, and observations with SPN's stakeholders, service providers, and clients at its 36 SRH centers, we developed hypotheses about client- and provider-side barriers that may inhibit postabortion family planning (PAFP) uptake. On the provider side, we found that the lack of benchmarks (such as the performance of other facilities) against which providers could compare their own performance and the lack of feedback on the performance were important barriers to PAFP uptake. We designed several variants of three interventions to address these barriers. Through conversations with team members at SPN's centralized support office and service providers at SPN centers, we prioritized a peer-comparison tool that allows providers at one center to compare their performance with that of other similar centers. We used feedback from the community of providers on the tools' usability and features to select a variant of the tool that also leverages and reinforces providers' strong intrinsic motivation to provide quality PAFP services. In this paper, we detail the process of identifying barriers and creating an intervention to overcome those barriers. The intervention's effectiveness will be tested with a center-level, stepped-wedge randomized control trial in which SPN's 36 centers will be randomly assigned to receive the intervention at 1-month intervals over a 6-month period. Existing medical record data will be used to monitor family planning uptake.

Sudden cardiac death in marathons: a systematic review.

The aim of this systematic review is to summarise the results of cohort studies that examined the incidence of SCD in marathons and to assess the quality of the methods used. A search of the PROSPERO international database revealed no prospective or published systematic reviews investigating SCD in marathons. The review was conducted using studies that reported and characterised the incidence of SCD in people participating in marathons. Studies were identified via electronic database searches (Medline, CINAHL, SPORTDiscus and Google Scholar) from January 1, 1966 to October 1, 2014 and through manual literature searches. 7 studies met the inclusion criteria and were included in this review. 6 of the studies were conducted in the USA and 1 in the UK. These studies covered a 34-year period involving between 215,413 and 3,949,000 runners. The SCD of between 4 and 28 people are recorded in the papers and the reported estimates of the incidence of SCD in marathons ranged widely from 0.6 to 1.9 per 100,000 runners. The proportion of those suffering SCD who were male ranged from 57.1% to 100% and the mean age reported in the papers, ranged from 37 to 48. This review raises 4 methodological concerns over i) collating reports of SCD in marathons; ii) time of death in relation to the marathon; iii) the use of registrants rather than runners in the estimates of sample size and iv) limited detail on runners exercise history. These four concerns all threaten the reliability and interpretation of any estimate of SCD incidence rates in marathons.  This review recommends that the methods used to collect data on SCD in marathons be improved and that a central reporting system be established.