Implementation of back to living well, a community-based program for the tertiary prevention of low back pain: a study protocol.

BACKGROUND: The current literature supports the effectiveness of exercise, education, and self-management interventions for the long-term management of persistent low back pain. However, there is significant uncertainty about the implementation of interventions related to barriers, facilitators, and patient's preferences. This study will evaluate the Back to Living Well program implementation from a participant and organizational perspective. More specifically we address the following objectives: 1) identify program barriers and facilitators from participants' perspectives, 2) identify factors related to program, personal and contextual factors that contribute to negative and positive outcomes, and outcome trajectories, 3) identify factors influencing participants' selection of an in-person or e-health program, and 4) evaluate program specific barriers and facilitators from the organization and care delivery perspectives. METHODS: This study will utilize a mixed-method convergent design including a longitudinal cohort strand and a longitudinal qualitative interview strand. The RE-AIM framework will be used to assess program implementation. Participants (n = 90, 1:1: in person or virtual) who choose to register in the program as well as staff (n = 10 to 15) involved in the delivery of the program will be invited to participate. Participants will participate in a 12-week physical activity, education, and self-management program. Implementation outcomes will be measured at 3-, 6-, 12-months, and six months after the end of the follow-ups. Interview scripts and directed content analysis will be constructed based on the Theoretical Domains Framework and the Neuromatrix Model of Pain, Theoretical Domains Framework. Staff interviews will be constructed and analyzed using the Consolidated Framework for Implementation Research. Participants will also complete pain, disability, quality of life and psychological questionnaires, wear an activity tracker at all time points, and complete weekly pain and activity limitation questions using a mobile application. DISCUSSION: The study results will provide evidence to inform potential future implementation of the program. An effective, appropriately targeted, and well implemented exercise program for the long-term management (i.e., tertiary prevention) of LBP could minimize the burden of the condition on patients, the health care system and society. TRIAL REGISTRATION: ClinicalTrials.gov NCT05929846. This (Registration Date: July 3 2023) study has been approved by the Hamilton Integrated Research Ethics Board Project ID#15,354.

Beliefs, Experiences, and Practices of Lady Health Workers in Facilitating Breastfeeding in Rural Communities in Pakistan.

Pakistan has extremely poor breastfeeding indicators: fewer than half of infants under 6 months are exclusively breastfed, only 20% of infants are breastfed within the first hour of life, and nearly half are never fed colostrum. The country's high infant morbidity and mortality is in part due to this suboptimal infant feeding. A network of lady health workers (LHWs) employed by the government facilitate maternal and child health programs, including breastfeeding support in their communities. This study describes LHWs' perspectives and experiences regarding breastfeeding. We conducted semi-structured interviews with 14 LHWs and used thematic qualitative analysis to code and analyze the data. Our research revealed that LHWs use their role as members of the community and involve influential members of the family to build trust. Frequent home visits beginning prenatally help them address misconceptions about infant feeding. While they have strong knowledge about the benefits of breastfeeding and the importance of colostrum, they demonstrate gaps in their knowledge regarding breast conditions, the safe preparation of human milk substitutes, the physiology of milk production, and supporting mothers who are separated from their baby. Future training should address these areas where LHWs lack knowledge to help mothers facilitate early and exclusive breastfeeding. With adequate training, LHWs are uniquely positioned to use their role as trusted members of the community to effectively counsel families on the importance of breastfeeding and support the clinical needs of women during the perinatal time.

Developing Community-Level Implementation Networks to Connect Older Adults to Evidence-Based Falls Prevention Programs.

Background: Evidence-based falls prevention programs are available in many communities, but participation in such programs remains low. This study aimed to develop community-based referral networks of organizations to facilitate the uptake of evidence-based falls prevention programs through engaging older adults at risk for falls with the RememberingWhen™ program and connecting them to evidence-based programs in Midwestern communities. Methods: Guided by the Practical, Robust Implementation and Sustainability Model (PRISM), referral networks were developed in two Midwestern communities (urban and micropolitan) through a seven-step community engagement plan: establishing and operationalizing the State-level Advisory Board (SAB), identifying falls prevention resources, conducting community assessments, developing Local Advisory Groups (LAG), operationalizing the LAG, developing referral network and protocols, and implementing the network. Semistructured interviews guided by the RE-AIM framework were conducted with members of the SAB, LAG, administrators and staff from organizations that participated in networks, and older adult participants. Results: After participating in the development of referral networks, participants felt they learned important skills that they can use to develop additional collaborations and networks in the future, emphasized the benefits of building community capacity among organizations with common missions. Interview data yielded strategies on enhancing the referral network's reach, impact, adoption, implementation efficiency, and maintenance. Conclusion: Future sustainability studies of such networks should explore identified challenges and strategies to sustain efforts. Results highlight the importance of ongoing funds to support the efforts of organizational networks in communities.

Acceptability of HIV Prevention Approaches Among USA Faith-Based Leaders.

HIV/AIDS disproportionately impacts underserved communities in the USA. This study evaluated the acceptability of partnering with faith communities to improve HIV prevention, screening, and engagement in care with a focus on Hispanic/Latinx (H/L) communities. We engaged faith-based leaders to identify how the cultural competence and foundations of trust within these communities may be leveraged to improve HIV-related healthcare access for underserved groups including H/L individuals. Using a semi-structured qualitative interview approach, we interviewed N = 20 faith-based leaders in Providence County, Rhode Island (RI). Data were analyzed using the framework approach which utilized inductive generation of themes and systematic grouping into predetermined categories. Seven of the 20 interviewees self-identified as H/L faith leaders and discussed needs specific to H/L communities including destigmatization of HIV, increased access to care, and partnerships founded on mutual respect. The other 13 faith leaders did not personally identify as H/L but all served communities with significant H/L populations. We included these individuals given their communities already performed HIV and/or other health outreach and could provide insight into what approaches could be adapted to the needs expressed by H/L leaders. All interviewees were accepting of developing partnerships with outside organizations to engage in HIV prevention, and all identified potential solutions to identified barriers. Results suggested that faith-based outreach should be further investigated as a method of improving HIV prevention in the general and H/L populations.

Development of a functional and psychosocial evaluation toolkit using mixed methodology in a community-based physical activity program for childhood cancer survivors.

PURPOSE: The evidence demonstrating the benefits of exercise and PA in patients and survivors of childhood cancer has been translated into a handful of community-based programs, such as the Pediatric cancer patients and survivors Engaging in Exercise for Recovery Program (PEER). To support the translation of research to practice, the next step in knowledge translation is to evaluate program effectiveness. An evaluation must consider the goals of the PEER program, feedback from key stakeholders, and logistics of this program. Thus, the purpose of this study was to develop an evaluation toolkit with an algorithm for the implementation of the PEER program. METHODS: Semi-structured interviews were conducted with three different groups (stakeholders in pediatric oncology, PEER parents, and PEER participants). The interviews were transcribed and coded by two independent reviewers. RESULTS: Key themes extracted from the interviews were split into physical and psychosocial themes. The most reported psychosocial themes were quality of life (QOL), fatigue/energy levels, fun, and cs; and physical themes included motor skills, physical literacy, and physical activity levels. Tools were compiled into the evaluation based on key themes identified as well as logistics of PEER. An algorithm was developed to tailor the evaluation to participants based on age and mobility. CONCLUSION: To date, this is the first evaluation toolkit and algorithm developed for a specific community-based PA program, the PEER program. The next step in knowledge translation will be to implement the evaluation to assess feasibility and share the evaluation for adoption within other developing programs.

Innovative participatory evaluation methodologies to assess and sustain multilevel impacts of two community-based physical activity programs for women in Colombia.

BACKGROUND: Community-based physical activity (PA) programs are appealing to women in Latin America and show potential for improving women's health. This study aimed to engage healthy middle-aged women, breast cancer survivors and local stakeholders participating in two publicly funded community-based PA programs in Bogotá, Colombia (Recreovía and My Body) to assess and visually map the perceived barriers, facilitators, and outcomes to promote programs' improvement, scaling and sustainability. METHODS: We used two participatory action research methods, the 1) Our Voice citizen science method to capture data and drive local change in built and social environmental facilitators and barriers that influence women's engagement in community-based PA; and 2) Ripple Effects Mapping to visually map the intended and unintended outcomes of PA programs. We used thematic analysis to classify the results at the individual, social, and community levels. RESULTS: The stakeholders engaged in the participatory evaluation included cross-sector actors from the programs (N = 6) and program users (total N = 34) from the two programs (Recreovía N = 16; My Body N = 18). Program users were women with a mean age of 55.7 years (SD = 8.03), 65% lived in low-income neighborhoods. They identified infrastructure as the main feature affecting PA, having both positive (e.g., appropriate facilities) and negative (e.g., poorly built areas for PA) effects. Regarding program improvements, stakeholders advocated for parks' cleaning, safety, and appropriate use. The most highlighted outcomes were the expansion and strengthening of social bonds and the engagement in collective wellbeing, which leveraged some participants' leadership skills for PA promotion strategies in their community. The facilitated dialogue among program users and stakeholders fostered the sustainability and expansion of the community-based PA programs, even during the COVID-19 pandemic. CONCLUSIONS: The implementation of both participatory methodologies provided a multidimensional understanding of the programs' impacts and multisectoral dialogues that fostered efforts to sustain the community-based PA programs.

Unmet health needs and barriers to health care among people experiencing homelessness in San Francisco's Mission District: a qualitative study.

BACKGROUND: People experiencing homelessness have unique health needs and barriers to medical and behavioral health care (mental health, substance use disorder, and overall well-being) compared to housed people. It remains unclear why many people experiencing homelessness do not access care when community-based homeless health care resources are available at low or no cost. This qualitative study examined perspectives of people experiencing homelessness and staff members at community-based homeless health and service organizations in San Francisco's Mission District on unmet medical and behavioral health needs and barriers to accessing care. METHODS: We conducted 34 interviews between September and November 2020: 23 with people experiencing homelessness and 11 with staff at community-based homeless health and service organizations in the Mission District. Qualitative interviews were transcribed, coded, and analyzed using the Framework Method on NVivo Qualitative Data Analysis Software. RESULTS: Both staff and homeless participants reported unmet and common health needs of mental illness, physical injury and disability, food and nutrition insecurity, and substance use disorder. Barriers to care included negative prior health care experiences, competing priorities, and provider turnover. Recommendations for improving services included building more trust with people experiencing homelessness by training clinic staff to treat patients with respect and patience and expanding clinical outreach and health education programs. CONCLUSIONS: People experiencing homelessness face many different health needs and barriers to care, some of which community-based organizations have the ability to address. These findings can help inform future strategies for homeless health care programs to identify and target the specific unmet health needs and barriers to care of people experiencing homelessness in their communities.

Perceptions of Inuit Women and Non-Inuit Healthcare Providers on the Implementation of Human Papillomavirus Self-Sampling as an Alternative Cervical Cancer Screening Method in Nunavik, Northern Quebec.

Human papillomavirus (HPV) self-sampling offers a cervical cancer (CC) screening alternative that can address certain barriers to the Papanicolaou test. As part of a larger community-based participatory project in Nunavik, Northern Québec, we travelled to two communities to gather perspectives from Inuit women and healthcare professionals (HCPs) on CC screening services and the possible implementation of HPV self-sampling. We held 10 group discussions with 28 Inuit women and 10 semi-structured interviews with 20 HCPs. The thematic analysis extracted themes reflecting one barrier and seven facilitators to accessing CC screening and the implementation of HPV self-sampling in Nunavik. Themes included, though not limited to, language and communication in health settings, access to culturally responsive educational resources on CC, and the noninvasive nature of HPV self-sampling. This study may serve to contribute to the co-development of a strategy for implementation that is designed according to the needs and priorities of the communities.

Practitioner Experiences Responding to Suicide Risk for Survivors of Human Trafficking in the Philippines.

Human trafficking survivors experience elevated suicide risk in comparison to the general population. Anti-trafficking service providers in the Philippines have identified capacity building in suicide prevention as a critical priority given the insufficient number of trained mental health professionals and lack of culturally adapted evidence-based interventions in the Philippines. We conducted a focused ethnography exploring the experiences of non-mental health professionals working in the anti-human trafficking sector in the Philippines in responding to suicidality among survivors of human trafficking (n = 20). Themes included: emotional burden on service providers, manifestations of stigma regarding suicide, lack of clarity regarding risk assessment, lack of mental health services and support systems, transferring responsibility to other providers, and the need for training, supervision, and organizational systems. We discuss implications for training service providers in the anti-human trafficking sector, as well as cultural adaptation of suicide prevention interventions with human trafficking survivors in the Philippines.

Stepping in and up to meet community needs: How community-based college access and success programs responded to COVID-19.

The current study uplifts the efforts of community-based college access and success programs (CAS) to support the college preparation, matriculation, and persistence of underserved students during COVID-19. Fifty-eight CAS across the United States completed an online survey that gathered information about organizational demographics, COVID-19 challenges, responses to challenges, and communication with constituents and funding needs during COVID-19. Results suggested CAS faced multiple challenges due to COVID-19 that affected the organization, staff, and constituents. Results also revealed organizations of varying sizes, locations, and demographics responded to challenges by revising existing programming for students, creating new programming for students and caretakers, and updating staff policies to meet ongoing and emergent needs despite limited resources. CAS are essential service providers for students who are under- and mis-served in formal education systems. Recommendations are provided for how such organizations can be invested in and better prepared for future disruptions.

Comparing Community-based Intergenerational Activities in Israel: Participants, Programs, and Perceived Outcomes.

This study investigated whether the content of different community-based intergenerational programs (IGPs) affects their perceived impact on older and younger participants. Data were collected through direct structured questionnaires administered to 84 older, and 96 younger participants, and were assessed using both quantitative and qualitative analyses. Different IGP types involved participants with differing background characteristics and were associated with different benefits and challenges. In art programs, older participants reported being more active and younger participants indicated more awareness of others, but also greater stress. Learning programs contributed to older persons' happiness, and younger persons' acquisition of new skills, but were also associated with divergent expectations between young and old, and a perception that young participants lacked commitment. Assistance programs attracted older participants with greater needs, and were associated with such benefits as alleviating older persons' loneliness, improving younger participants' satisfaction from helping, but also involved challenges pertaining to the relationship termination. Generally, older participants reported more benefits than younger persons. The results highlight the need to differentiate between IGP types, a distinction not addressed in previous studies. The combination of activity content and participant characteristics and needs may lead to different perceived program impacts.

Playing With Peers: Exploring Peer Support Mechanisms of a Type 2 Diabetes-Specific Board Game.

In this study, we explored specific mechanisms of a board game developed to facilitate peer support among people with Type 2 diabetes attending group-based diabetes education. The game was tested with 76 people with Type 2 diabetes who participated in focus groups after the game. Data from observations of audio-recorded games and focus groups were analyzed using Interpretive Description. Six mechanisms facilitating peer support among people with Type 2 diabetes were identified: (a) entering a safe space of normality created by emotional in-game mirroring; (b) mutual in-game acknowledgment of out-of-game efforts; (c) forming relationships through in-game humor; (d) health care professionals using game rules to support group dialogues of interest to people with Type 2 diabetes; (e) being inspired by in-game exchange of tips and tricks; and (f) co-players guiding each other during the game. Peer support was inhibited by the mechanism of game rules obstructing group dialogues.

Harm Reduction for Women in Treatment for Alcohol Use Problems: Exploring the Impact of Dominant Addiction Discourse.

The objectives of this study were to profile the landscape of women's alcohol use programs in Canada. We explored service users' and providers' beliefs about alcohol use problems and how this affected treatment choices for alcohol use problems. Data were collected through standardized measures alongside in-depth semi-structured narrative interviews in six women's alcohol treatment sites in Canada. Findings demonstrated that service users and service providers often supported an abstinence choice and were ambivalent about the viability of controlled or managed use in both abstinence- and harm reduction-based programs. Findings showed that women service users in this study had significant rates of trauma and depression which were associated with their alcohol use; the majority still adopted dominant alcohol addiction discourse which emphasizes the need for abstinence. We offer a number of recommendations to improve the viability of harm reduction for alcohol use in women's treatment programs.

Access to Multicultural Children's Literature During COVID-19.

Amid the COVID-19 pandemic, students, families, and educators have faced unprecedented challenges. These challenges have disproportionately impacted racially/ethnically diverse, low-income communities because of long-standing health system, socioeconomic, and educational inequities. With closures of schools, libraries, and childcare centers, many students were disconnected from their community and did not have access to books. Parents' and educators' concerns centered around students falling behind academically and socially. In this article, we explain the motivation and rationale for a social justice initiative to provide students of color from low-poverty areas with access to high-quality multicultural children's literature at home. We describe our literacy partnership with a local after-school program serving participant students and families, research underpinning the initiative, and our process for selecting high-quality multicultural literature book sets and offer suggestions about how to facilitate comprehension and motivational support for home-based reading. We also offer a list of recommended literature and discuss outcomes and implications of this project.

Taxonomy of Seniors' Needs for Food and Food Assistance in the United States.

Food insecurity results in poor health among seniors. Food and nutrition assistance targeted to seniors experiencing or at risk of food insecurity prevents poor health outcomes and enables seniors to age in place. Currently, the primary modes of service delivery are targeted to seniors who are older and frailer than average, rendering these modes less responsive to the needs of the broader population of food-insecure seniors and limiting the preventive potential of food assistance. This study aimed to understand needs among seniors for food and food assistance and to develop a comprehensive taxonomy for these needs. The taxonomy depicts seniors' self-identified needs that relate to their ability to access and use food and nutrition assistance across three domains: physical abilities, consuming food, and access and use of transportation. The results of this study are intended to provide in-depth information to support effective alignment of programs with seniors' needs.

Listening to the Voices of Community Health Workers: A Multilevel, Culture-Centered Approach to Overcoming Structural Barriers in U.S. Latinx Communities.

Community Health Workers (CHWs) are often incorporated into efforts to reduce health disparities for vulnerable populations. However, their voices are rarely the focus of research when considering how to increase their job effectiveness and sustainability. The current study addresses this gap by privileging the voices of 28 CHWs who work with Latinx communities in Nebraska through in-depth, semistructured interviews. Using a multilevel, Culture-Centered Approach (CCA) to Health Communication, we identified two key structural communication issues: (a) increasing language accommodation and (b) increasing (and stabilizing) network integration across three ecological levels of health behavior (individual, microsystem, and exosystem). This study shows the uniquely valuable perspective that CHWs have as they navigate hierarchical health care structures and community cultures to meet the needs of their Latinx clients. Findings suggest that CHWs should be included in health care organization and policy discussions to reduce health disparities for Latinx populations.

Unintended Consequences of Community Health Worker Programs in South Africa.

Task shifting from trained clinicians to community health workers (CHWs) is a central, primary health care strategy advocated by global health policy planners in resource-poor settings where trained health professionals are scarce. The evidence base for the efficacy of these programs, however, is limited-in particular, research that identifies their potential unintended consequences. Based on sustained ethnographic study of CHWs working for AIDS projects in South Africa at the height of the country's AIDS epidemic, this article identifies how structural and local factors produced unintended consequences for CHW programs. These consequences were (a) CHWs moonlighting for multiple organizations, (b) CHWs freelancing in communities without regulation, and (c) adverse patient outcomes resulting from uncoordinated care. These consequences stemmed from structural elements of a bureaucratically weak health system and from local grassroots dynamics that jeopardized long-term CHW program sustainability and eroded national health goals.

Using PhotoVoice to Understand Health Determinants of Formerly Homeless Individuals Living in Permanent Housing in Detroit.

Housing First is an evidence-based approach to addressing chronic homelessness that provides permanent, low-barrier housing. Previous literature on the health of tenants of Housing First programs has primarily focused on mental health, substance use, and health care. Using the social-ecological model, we conducted a community-based participatory research (CBPR) PhotoVoice study to better understand what Housing First residents in Detroit identify as factors that impact their health. Seventeen participants were provided cameras and photography training and asked to take photos on the theme "What impacts your health and wellness?" Group sessions were held to discuss photos. Results were organized into four themes: (a) loss of jobs hurts people and communities; (b) blight, more than just abandoned buildings; (c) being pushed out by development; and (d) experiencing the "battlefield" versus feeling peaceful. The social-ecological model was used to indicate potential interventions indicated by study findings.

"I Gotta Go With Modern Technology, So I'm Gonna Give 'em the Narcan": The Diffusion of Innovations and an Opioid Overdose Prevention Program.

Fatal opioid overdoses can be prevented by opioid overdose prevention programs (OOPPs). The present study qualitatively examined the diffusion process of an OOPP among 30 persons who inject drugs (PWIDs) in an opioid-saturated community. Purposive sampling was used to recruit participants into three groups based on familiarity with the OOPP. Findings revealed that participants often adopted the OOPP, which was offered by a local harm reduction organization, if first exposed by staff hosting and implementing it. Barriers to adoption included belief that OOPP training was lengthy or unnecessary, lack of perceived relative advantage, nonengagement with the host organization, and trepidation of administering withdrawal-causing medication to fellow PWIDs. Participants outside of networks diffusing the OOPP were isolated from other PWIDs. Staff from the host organization were influential in encouraging OOPP adoption, which underscores their importance in the effort to reduce fatal overdoses.

Nurturing maternal health in the midst of difficult life circumstances: a qualitative study of women and providers connected to a community-based perinatal program.

BACKGROUND: Many socioecological and structural factors affect women's diets, physical activity, and her access and receptivity to perinatal care. We sought to explore women's and providers' perceptions and experiences of health in the pre- and post-natal period while facing difficult life circumstances, and accessing a community-based program partially funded by Canada Prenatal Nutrition Program (CPNP) in Alberta, Canada. METHODS: Following the principles of community-based participatory research, we conducted a focused ethnography that involved five focus groups with women (28 in total), eight one-on-one interviews with program providers, and observations of program activities. Data were analyzed through qualitative content analysis to inductively derive codes and categories. RESULTS: Women perceived eating healthy foods, taking prenatal vitamins, and being physically active as key health behaviours during pregnancy and postpartum. However, they were commonly coping with many difficult life circumstances, and faced health barriers for themselves and their babies. These barriers included pregnancy or birth complications, family and spousal issues, financial difficulties, and living rurally. On the other hand, women and providers identified many aspects of the community-based program that addressed the burden of adversities as enablers to better health during pregnancy and postpartum. CONCLUSION: Community-based programs have an important role in alleviating some of the burden of coping with difficult life circumstances for women. With such potential, community-based programs need to be well supported through policies. Policies supporting these programs, and ensuring adequate funding, can enable more equitable services to rural women and truly promote maternal health during pregnancy and postpartum.