Health Education & Behavior最新文献

BackgroundTo build research capacity for early-career faculty conducting HIV/STI research with minoritized communities and to enhance diversity in the scientific workforce, the University of California, San Francisco (UCSF) Center for AIDS Prevention (CAPS) conducts a training program for visiting professors (VPs), begun in 1996. VPs are in residence at CAPS for three summers, complete a pilot research project, and prepare National Institutes of Health (NIH) grant proposals. Best practices and key elements for successfully training scholars of color, and others who work with minoritized communities, are identified.MethodsThis paper draws on qualitative interviews with 31 VPs and 10 program mentors (VPMs) who participated in the program between 1996 and 2016. All VPs were also invited to participate in an anonymous survey to assess potential differences between study participants and non-participants. Interviews took place between September 2017 and March 2018 and were audio-recorded, transcribed, and thematically coded.ResultsVPs and VPMs described key elements relevant to both human and social capital that contributed to Program success. Paramount among these were the importance of establishing trusting mentorship relationships; sustained collegial engagement over time; and fostering a training environment based on multidisciplinarity, skills-building, scholarly networking, and peer reviews.ConclusionsParticipant voices from this objectively successful training program provide directions for future initiatives to support scholars of color and those working with minoritized groups. An indispensable value of such programs is to intentionally foster trusted scholarly communities to counterbalance systemic inequities in the academy.

Little is known about how distance learning impacts delivery of the National Diabetes Prevention Program (DPP) despite a rapid shift to this platform during the coronavirus disease 2019 (COVID-19) public health emergency. We explored how a workplace DPP, delivered via distance learning, impacted knowledge, motivation, and behavioral skills of participants throughout the program. We conducted repeated qualitative interviews with distance learning participants at baseline, 6 months, and 12 months from September 2020 to July 2022. Three study team members coded interview data using individual responses as the unit of analysis. We used a thematic approach, using the information-motivation-behavioral skills framework, to analyze responses and generate understanding of the program's impact. The 27 individuals who participated in the interviews (89% women, mean age 56 years) reported the distance learning platform was effective in changing their behavior. The program's focus on food logging and setting limits on specific types of caloric intake was perceived as essential. Education on ideal levels of fat and sugar consumption, lessons on how to read food labels, and dissemination of recipes with healthy food substitutions allowed participants to initiate and sustain healthy decision-making. Strategies to increase physical activity, including breaking up exercise throughout the day, made reaching their goals more feasible. Participants reported food logging and weight reporting, as well as group support during sessions, either sustained or increased their motivation to adhere to the program over time. A workplace DPP delivered via distance learning successfully prompted improvements in the knowledge, motivation, and behavioral skills necessary to increase healthy eating and physical activity among participants.

Third- and fourth-year U.S. medical students applying to residency were surveyed between August 6 and October 22, 2022, to assess the impact of Dobbs v. Jackson Women's Health Organization (Dobbs) on medical student residency application location choices. Across all medical specialties, most respondents were unlikely or very unlikely to apply to one or more residency programs located in a state with abortion restrictions (57.9%) and were considering changes in state abortion access when choosing the location of residencies to apply to (77.0%). Respondents in states with no abortion restrictions were less likely to apply to a program in a state with abortion restrictions (2 [1, 3] p < .001). The Dobbs decision significantly impacts residency application decisions for medical students in all specialties. Students are choosing to avoid or target states with restrictive abortion legislation based on their personal views.

IntroductionThe COVID-19 pandemic disproportionately impacted ethnic minority and other underserved communities, prompting the federal government to fund community-led health literacy initiatives. This evaluation shares challenges and lessons learned, and identifies best practices from community-based organizations (CBOs) partnering with academia and local government to support health literacy programming.MethodsIn 2023, 20 representatives from 12 CBOs in Southern California responded to an interviewer-administered survey, including open-ended questions about lessons learned. We analyze text data to identify key themes.ResultsCBOs expressed a need for additional financial resources and technical assistance, including grantsmanship training, access to in-language resources, support to build and use in-house evaluation systems, and greater university oversight for student collaborators. Respondents highlighted the importance of community engagement efforts to build trust and enhance the uptake of programming. They also stressed the need for specialized training of community health workers engaged in health programs and the utilization of population sub-group data to inform policy and funding development to better serve communities' needs.ConclusionCBOs are eager to partner with government and academia and acknowledge the need for targeted support and resources that can be facilitated through multisectoral partnerships. We offer recommendations and actionable strategies for funders and academia to create and improve equitable partnerships with CBOs. Partnerships that address the needs and systemic barriers experienced by ethnic minority communities will support local public health goals while fostering resilience and health equity.

This study aimed to describe barriers athletic trainers (ATs) face to implementing expert recommendations for improving athletes' concussion care-seeking behavior. We distributed an electronic survey through the National Athletic Trainers' Association to 9,997 ATs working in secondary schools or collegiate institutions and received 365 complete responses. We quantitatively measured their barriers using a validated survey based on the Capability, Opportunity, Motivation, Behavior (COM-B) behavior system containing six Likert-type items with a scale of 0 to 10 (labeled Strongly Disagree-Strongly Agree). We performed three analyses: (a) descriptive analysis of COM-B responses, (b) separate ordinal regression analyses to determine if gender, years certified, percent of employment hours spent at their school, or setting (e.g., secondary school or college/university) predict COM-B responses, and (c) group comparisons within types of secondary schools and collegiate institutions. Athletic trainers reported the highest barriers in the opportunity-related constructs followed by capability-related and motivation-related constructs. Practicing in a secondary school, rather than college/university, setting predicted stronger barriers in psychological capability, social opportunity, physical opportunity, and automatic motivation. Athletic trainers at National Collegiate Athletic Association (NCAA) affiliated colleges/universities had higher physical and psychological capability, compared to ATs at non-NCAA-affiliated colleges/universities. Athletic trainers feel motivated and capable of employing practices to improve athlete care-seeking after a concussion, but they face barriers. Organizations should support ATs by providing opportunities to deliver concussion education. Secondary schools and non-NCAA institutions may benefit from resources to reduce barriers to providing concussion education, like toolkits to help deliver concussion education and protected time to providing this education.

First-generation Latinx immigrant youth from the Northern Triangle (NT; El Salvador, Guatemala, and Honduras) face unique risks for experiencing stressors across the phases of migration, which could exacerbate their mental health. This study aimed to (a) identify and characterize unique latent profile groups based on response patterns to immigrant minority stress and psychosocial protective factor items and (b) examine the associations of latent profile membership with depression and anxiety symptoms among NT immigrant youth, controlling for study covariates (i.e., postmigration victimization and forced immigration-related family separation). Primary surveys assessing immigrant minority stress and psychosocial protective factors (i.e., ethnic identity importance, and family, peer, and school support) were administered (N = 172, age range = 14-21, 63% female). Latent profile analysis (Aim 1) and multiple linear regression (Aim 2) were conducted to examine the study aims. A three latent profile model was identified: (a) moderate immigrant minority stress and low psychosocial protection (weak resources), (b) moderate immigrant minority stress and moderate psychosocial protection (average resources), and (c) low immigrant minority stress and high psychosocial protection (strong resources) during postmigration. Multiple linear regression demonstrated that latent profile membership was significantly associated with mental health. Protective associations with mental health were consistently present among the strong resources group. Detrimental associations with mental health were consistently present among the weak resources group. The average resources group demonstrated both protective and detrimental associations with mental health. Postmigration victimization and forced immigration-related family separation covariates were significantly associated with mental health. Findings provide a foundation for further mental health prevention research with NT immigrant youth.

The predominant method for treating obesity has been suggesting and providing information on a controlled diet and, to a lesser extent, increased exercise. That approach has largely failed beyond the short term for many decades as obesity rates continue to rise. Therefore, leveraging improvements in psychosocial correlates of weight-loss behaviors has sometimes been suggested instead. The aim of this study was evaluation of targeted improvements in self-regulation and self-efficacy within a theoretically derived weight-loss program. Women with obesity (N = 103) participated in a year-long community-based program emphasizing self-regulatory skills development to counter lifestyle barriers/challenges to first exercise, then controlled eating. Within a structured treatment protocol administered by community facility employees-and based on tenets of social cognitive theory, self-regulation theory, self-efficacy theory, and coaction theory-self-regulatory skills were initially developed to foster adherence to exercise. Those skills were then adapted to promote eating-behavior changes, emphasizing fruit and vegetable intake. Improvements in measures of exercise self-regulation, eating self-regulation, and self-efficacy for controlling eating, their corresponding behaviors, and weight and waist circumference were significant. Greater within-participant carry-over of changes in exercise self-regulation to eating self-regulation was significantly associated with more weight and waist circumference reductions over both 6 and 12 months. Change in eating-related self-efficacy significantly mediated those relationships. The mean weight reduction of approximately 6% indicated positive effects on obesity-related health risks. The community-based setting indicated potentials for large-scale dissemination of theory- and evidence-driven behavioral obesity treatments focused primarily on self-regulatory skills development.

Growing research highlights the role of local community contexts in health and well-being. Communities function as central arenas for health promotion as individuals and community spaces interact in daily life. To better communicate the linkages between community and health, we demonstrate the use of a set of geosocial tools for community diagnosis and health promotion, conceptually grounded in the framework of geosocial embeddedness, using data from community surveys and participatory research conducted with local inhabitants to engage their competency. Through a web-based interactive map generated using a geographic information system, we identified public territories in the municipality where greater policy attention is needed to enhance health. Through an intersectional matrix produced using multilevel analysis, we identified precise social groups by intersectional categories that are most at risk of loneliness for targeted intervention. A health radar chart on multidomain indicators illustrated information on group dynamics and longitudinal comparisons for health promotion. Overall, these tools offered not only diagnoses of the most vulnerable social groups for tailored interventions but also insight for policymakers to improve infrastructure and material resources to promote health. We conclude that geosocial tools offer a promising approach toward sharpening health communication and improving health in the community.

Similar to national trends, in Illinois, fatal opioid overdoses have risen. Black men (35+) outrank all other racial subgroups for the highest rate of fatal opioid overdoses in the state. To address this, Prevention First and the Illinois Department of Human Services developed a public health education campaign to support increasing enrollment in recovery services, with a focus on Black men (35+). Self-reported Black participants with opioid use disorder (OUD) made up the analytic sample. Study goals were to understand lived experiences of the campaign audience; investigate knowledge, attitudes, and beliefs regarding OUD and treatment; explore perceived barriers and facilitators to treatment; and evaluate messaging that showcased medication-assisted recovery (MAR) as a viable tool for treatment and recovery. Interviews were recorded and transcribed for thematic analysis. Participants shared long and cyclical journeys of use and recovery. Participants had low levels of knowledge of available treatment options and struggled to imagine themselves in recovery because of the fear of cravings and withdrawal. Messaging that was realistic about the cyclical nature of recovery, showed the varying options for MAR, and addressed cravings and withdrawals were well received. These findings illustrate the importance of understanding an audience and involving them in campaign development to create messaging that promotes behavior change and sustained health. Through the Decision Blocks strategic framework, we discovered information gaps, barriers to treatment, and practical solutions to increase access to treatment for Black men with OUD that has been limited due to inequities caused by structural racism.

With health equity growing as a priority within health care, health systems must transform that calling into action within their social, economic, and political environments. The current literature has not compared how different organizations manage the same health disparities intervention. This qualitative study aims to illustrate how different organizations navigated the implementation and sustainability of a hypertension disparities intervention by comparing experiences across Federally Qualified Health Centers (FQHCs), a private health system, and other non-clinical partnering organizations. As a study within a randomized controlled trial designed to reduce disparities in hypertension care, we conducted interviews with health care leaders before and after participation in the trial's multi-level intervention. Before participation, we interviewed five health care leaders representing five health systems. Following the intervention, we interviewed 14 leaders representing the five health systems and two partnering organizations. Discussions focused on intervention implementation and plans for sustainability. The primary considerations in implementation were appropriate staffing and multi-level organizational buy-in. When discussing long-term planning, health systems prioritized the structure of a stepped-care protocol incorporating community health workers (CHWs) and case managers. The sustainability of the CHW intervention at FQHCs was dependent on funding, whereas a private, non-FQHC physician practice network focused on expanding current resources for more patients. These findings serve as anticipatory guidance for organizations aiming to reduce hypertension disparities and provide support for policies that financially assist these interventions. Further investigation is warranted on the organizational factors that may influence the degree of success in eliminating health care disparities.