Health Promotion Practice最新文献

Introduction. Effective empathic communication between health care providers and patients is an essential part of health care. In resource-poor contexts, evidence is needed to understand the quality and content of health care communication within real-life clinical engagements. We used the existing Enhancing Assessment of Common Therapeutic Factors (ENACT) tool to measure empathic communication skills among a group of community health workers (CHWs) receiving a novel quality improvement intervention called Nyamekela4Care in South Africa. Methods. In two resource-limited sites in the Western Cape, South Africa, we audio-recorded CHWs, with consent, in routine client consultations at baseline and postintervention. All sessions were in Afrikaans. We used the adapted ENACT tool to rate recordings at both timepoints, assessing 11 items including communication skills, emotional engagement, process and interaction. We used ANOVA to assess preimplementation and postimplementation differences in empathic communication, and analyzed coders' feedback on the coding process itself. Results. We analyzed n = 66 recordings from 11 CHWs, observing positive directionality overall, with most skills improving over time. Despite near-significant improvements in communication delivery (p = .083), self-confidence/groundedness (p = .029) significantly changed but in the opposite direction. Large effect sizes were observed in verbal communication, responsiveness to client, and identifying external resources, with no significant difference between timepoints. ENACT was feasible to apply to audio recordings; inter-coder reliability was suboptimal despite coder training and ongoing monitoring and support. Discussion. Quality improvement interventions may improve empathic skills in diverse contexts, and our results demonstrate how empathic skills could be more routinely assessed in low-resource health care settings.

Data visualization, such as figures created through network analysis, may be one way to present more complete information from qualitative analysis. Segments of qualitatively coded data can be treated as objects in network analysis, thus creating visual representations of the code frequency (i.e., nodes) and the co-occurrence (i.e., edges). By sharing an example of network analysis applied to qualitative data, and then comparing our process with other applications, our goal is to help other researchers reflect on how this approach may support their interpretation and visualization of qualitative data. A total of 265 de-identified transcripts between help-seekers and National Child Abuse Hotline crisis counselors were included in the network analysis. Post-conversation surveys, including help-seekers' perceptions of the conversations, were also included in the analysis. Qualitative content analysis was conducted, which was quantified as the presence or absence of each code within a transcript. Then, we divided the dataset based on help-seekers' perceptions. Individuals who responded that they "Yes/Maybe" felt more hopeful after the conversation were in the "hopeful" dataset, while those who answered "No" were in the "unhopeful" dataset. This information was imported to UCINET to create co-occurrence matrices. Gephi was used to visualize the network. Overall, code co-occurrence networks in hopeful conversations were denser. Furthermore, the average degree was higher in these hopeful conversations, suggesting more codes were consistently present. Codes in hopeful conversations included information, counselor support, and problem-solving. Conversely, non-hopeful conversations focused on information. Overall, network analysis revealed patterns that were not evident through traditional qualitative analysis.

Traumatic experiences are highly prevalent among people experiencing homelessness who face structural inequities, which may impact engagement in research. Research staff ("staff") working with people experiencing homelessness are under-equipped to cope with structural inequities and the trauma present in participants' lives, even if they are well-trained in the regulatory aspects of the research process. Six staff involved in tobacco cessation intervention research with people experiencing homelessness described their experiences and highlighted areas of training to integrate trauma-informed and resilience-building approaches to support field staff and people experiencing homelessness. We identified three themes: (a) impact of trauma on the research process; (b) the importance of engagement with community partners and participants; and (b) the need for a field worker's guide. Staff described being the bearers of participants' traumas, while also coping with their own vicarious traumatization. Staff believed they would benefit from a fieldworker's guide that includes best practices for engagement with community partners as well as trauma-informed approaches like training in trauma-informed care and tools to address vicarious traumatization. Resilience-building approaches include real-time debriefing to celebrate successes and troubleshoot problems in the field. Training in resilience-building can be integrated as part of the general training required of all research staff prior to conducting intervention research studies with people experiencing homelessness. These approaches may need institutional support to be integrated into standard research workflows. In doing so, they may not only safeguard research staff and participants but also promote research as a means to dismantle inequities by being inclusive, safe, and empowering.

HIV disproportionately affects adolescent girls and young women living in Southern Africa. Rates of perinatal HIV transmission are high in this population, emphasizing the need for targeted health promotion and public health programming to improve the health of young mothers living with HIV. Zvandiri, a non-profit organization in Zimbabwe, created the Young Mentor Mother (YMM) program in response to this issue. This health promotion program uses peer-led service delivery conducted by trained young mothers living with HIV, called YMMs. We conducted semi-structured virtual interviews (N = 29) among Zvandiri staff and YMMs to identify benefits and challenges, and to inform future program scaling. We applied thematic analyses to the transcriptions. Participant narratives revealed several themes, including three key benefits from the YMM program: (1) peer support, (2) holistic care, and (3) women's empowerment. Participants also shared barriers to the success of the program, reflecting two overarching dimensions: (1) barriers related to scaling up the YMM program and (2) challenges related to addressing socio-structural factors. Barriers to scale-up included limited funds and resources, and food insecurity. Socio-structural challenges included HIV-related stigma, cultural and geographic differences, and intimate partner violence (IPV). These challenges align with the social-ecological model, whereby structural factors (lack of funding, food insecurity), community factors (HIV-related stigma, socio-cultural differences in accepting HIV care), and interpersonal factors (IPV) affect the implementation and scale-up of the program. We recommend future adopters of the YMM program to tailor the model for their community, prioritize peer supporter's well-being, foster women's empowerment, and adopt a holistic care approach.

The objective of this study was to assess the effectiveness of a nature prescription program on mental, physical, and social health offered to Salt Lake County employees. The program was conducted in two separate phases during 2020 and 2021 by a wellness program for Salt Lake County employees. Participants received a nature prescription and bi-weekly newsletters, and were offered additional wellness benefits for completing weekly prescriptions. Data were collected by a post-survey that assessed participants' time spent outdoors, perceived health benefits (physical, mental, and social), and perceived benefit of the nature prescription program. Due to the post only study design, descriptive statistics were calculated and analyzed. About two-thirds of participants were female. Of the 285 participants who completed the 2020 post-survey, the majority reported improved mood, decreased stress and sedentary behavior, improved anxiety and relationships with others, and increased energy. In addition, almost half reported improved cognition and an increased connection with their community. Of the 143 first-time participants who completed the 2021 post-survey, similar results were found where the majority reported improved mood and relationships with others, decreased stress and sedentary behavior, and increased energy. The cost of the 2020 program, aside from employee salary, was US$1.52 per completed participant. The success of this program provides evidence to suggest that incorporating nature prescriptions into employee wellness programs is both beneficial and cost effective.

There is a pressing need to increase the health care and public health workforce in rural communities across the United States. In Colorado, many of the rural communities are medically underserved, lacking resources and employment prospects to appropriately address the health needs of its communities. A potential strategy to address these medically underserved areas and the public health workforce shortage is to develop pathway programs for rural adolescents into health-related careers. The Rural Youth Public Health Summit (Summit) was a pilot pathway program for rural secondary school students hosted at a 4-year public university. The planning and formation of the Summit were done through the collaboration of school administration and teachers, university faculty and staff, educational non-profits, and health care and public health professionals. The Summit's goals were to increase awareness and interest in public health careers and to further partnerships between a university and rural secondary schools. Participants included 22 secondary school students and 10 chaperones from rural schools. Throughout the 2-day Summit, participants engaged in campus tours, a keynote speaker, workshops facilitated by faculty and public health professionals, and an overnight stay in the dorms. Despite some limitations, the Summit showed promising results as a pilot program in its ability to conduct planning, outreach, recruitment, and facilitation of a pathway program to connect rural adolescents to college education and career opportunities in public health.

SARS-CoV-2 (COVID-19) caused disruptions and challenges across the globe, and many public health interventions focused on addressing immediate and emergent needs directly related to COVID-19. At the same time, other community health needs persisted, and intervention collaborators faced new challenges with reaching their communities. One such intervention was the InSideOut Initiative, a systems approach aimed at creating more supportive cultures for school-aged athletes by assisting school leaders, athletics administrators, and coaches with developing social and emotional competencies. Formerly, an initiative dependent on in-person trainings, as a result of COVID-19, InSideOut needed to pivot their approach. InSideOut executives and intervention collaborators were interviewed to better understand what adaptations were made and what lessons were learned to continue their mission. Findings point to three primary themes: prioritizing the community, implementation innovations, and being open to content additions and adaptations. Future public health interventions could benefit from incorporating community assessment, remaining open to social innovation, actively looking for new solutions, and integrating formative, process, and outcome evaluation processes.

LGBTQI+ individuals often face health disparities, with encumbered outcomes. We investigated the perspectives of a wide range of Greek health professionals using a battery of questionnaires examining LGBTQI+ health-related knowledge, attitudes, and clinical preparedness, while exploring the potential challenges they face when providing care for LGBTQI+ patients via qualitative analysis of their free text answers. In total, 220 health professionals participated, including physicians, nurses, dentists, physiotherapists, social workers, nutritionists, medical laboratory professionals, pharmacists, radiographers, and health promotion specialists. Four main themes were revealed concerning the barriers to providing equitable and patient-centered care to LGBTQI+ individuals: (1) Inadequate knowledge (1a. Distinctive health issues of the LGBTQI+ community, 1b. Community-related terminology), (2) Insufficient communication skills (2a. General approach of LGBTQI+ patients, 2b. Addressing LGBTQI+ individuals, 2c. Managing critical attitudes of colleagues/third parties), (3) Personal perceptions (3a. Attitudes toward the LGBTQI+ community, 3b. Perceptions on the necessity of sexual health history), and (4) Ambiguous bureaucratic procedures. Self-identification, contact with community members in personal life, as well as LGBTQI+ patients' openness during the encounter were reportedly enabling inclusive care. Most participants (83.2%) expressed willingness for further training on LGBTQI+ health issues. Going forward, study participants identified this field, in conjunction with communication skills, as important areas of focus for training health providers and empowering them to provide equitable, patient-centered, high-quality care to the LGBTQI+ community.

Multisector community partnerships (MCPs) are a key element of the public health approach to addressing social determinants of health (SDOH). The Improving SDOH-Getting Further Faster (GFF) retrospective evaluation of MCP-driven SDOH interventions was designed to generate practice-based evidence that can help guide partnerships' efforts to improve chronic disease outcomes and advance health equity by addressing SDOH. This article shares Year 2 GFF findings related to sustainability strategies for partnerships focused on SDOH and their interventions. GFF partnerships' reported sustainability strategies, including establishing shared goals and increasing partners' capacity for SDOH work through training, align well with the rich coalition building evidence base. Findings also indicate some evolution of sustainability strategies, such as adopting team-based, decentralized leadership models to help guard against partner or staff turnover. Organizations looking to form, fund, or provide technical assistance to MCPs that address SDOH can use the practice-based insights shared in this research brief to plan ahead for sustainability.

To support meaningful and productive engagement in cancer research, we provide practical guidance for preparing for and conducting focus groups and interviews with community members. We provide 11 recommendations in two printable resources: (a) a checklist for preparing for focus groups and interviews with community members, and (b) a list of practical strategies to use when conducting the focus groups and interviews. These recommendations are based on our experience facilitating 15 focus groups and 20 interviews with 52 community members to codesign the study materials for a population-wide qualitative survey for understanding the needs and experiences of adults affected by cancer in Queensland, Australia. The checklist includes six recommendations: (1) define and document recruitment procedures, (2) use diverse recruitment methods to recruit a diverse sample, (3) implement multiple strategies to prevent and detect fraudulent participant sign-ups, (4) offer flexible options for research participation, (5) develop and pilot visual session materials, and (6) nominate lead and support facilitators (focus groups only). Practical strategies include five recommendations with examples for how to implement these in practice: (1) allow time to get started, (2) invite focused participation, (3) keep track of time, (4) facilitate productive and insightful conversations, and (5) debrief after sessions for continuous quality improvement. These resources can be used by students, researchers, and health care professionals conducting focus groups and interviews with community members to optimize the consumer's experience of participation in cancer research. The recommendations presented may also be applicable in health research more broadly.