Implementation evaluation of a collective impact initiative to promote adolescent health in Oklahoma County, USA

Background The teenage birth rate in the USA has considerably decreased in recent decades; however, more innovative, collaborative approaches are needed to promote adolescent health and prevent teenage pregnancy at the community level. Despite literature on the promising results of the collective impact (CI) model for health promotion, there is limited literature on the model’s ability to reduce teenage pregnancies in a community. The Central Oklahoma Teen Pregnancy Prevention Collaboration is applying the CI model to foster collaboration among multiple stakeholders with the goal of increasing community and organizational capacity to improve adolescent health outcomes. This paper reports the findings from the initiative’s implementation evaluation, which sought to understand whether the CI model improved collaboration among organizations and understand barriers and facilitators that affected program delivery. Methods Program implementers and evaluators jointly developed research questions to guide the intervention and evaluation design. The Consolidated Framework for Implementation Research (CFIR) was used to assess program components including the intervention characteristics, organization setting, community setting, facilitator characteristics, and the process of implementation. Primary sources of data included performance measures, meeting observations (n = 11), and semi-structured interviews (n = 10). The data was thematically analyzed using CFIR constructs, community capacity domains, and the five constructs of CI. Results Key findings include the need for shortened meeting times for meaningful engagement, opportunities for organizations to take on more active roles in the Collaboration, and enhanced community context expertise (i.e., those with lived experience) in all Collaboration initiatives. We identified additional elements to the core constructs of CI that are necessary for successful implementation: distinct role identification for partner organizations and incorporation of equity and inclusivity into collaboration processes and procedures. Conclusions Results from this implementation evaluation provide valuable insights into implementation fidelity, participant experience, and implementation reach of an innovative, systems-level program. Findings demonstrate the context and requirements needed to successfully implement this innovative program approach and CI overall. Additional core elements for CI are identified and contribute to the growing body of literature on successful CI initiatives.

Learning from the land (Nunami iliharniq): Reflecting on relational accountability in land-based learning and cross-cultural research in Uqšuqtuuq (Gjoa Haven, Nunavut)

The land is where Inuit knowledge transfer has taken place for generations. Land-based programs for learning and healing have been increasingly initiated across Inuit Nunangat in support of Inuit knowledge transfer that was disrupted by colonial settlement policies and imposed governance systems. We worked with Elders in Uqšuqtuuq (Gjoa Haven, Nunavut) to develop a project to understand the connections between caribou and community well-being. They emphasized that Elder–youth land camps are the most effective means for Elders to share their knowledge, for youth to learn, and for researchers to engage in respectful research. We used the Qaggiq Model for Inuktut knowledge renewal as a guiding framework, and we followed the direction of a land camp planning committee to plan, facilitate, and follow-up on three land camps (2011–2013). The Qaggiq Model also outlines the Qaggiq Dialogue as a way of engaging in relational accountability according to Inuit context and values. In this paper, we reflect on the complexities of upholding relational accountability in cross-cultural research — as part of entering into a Qaggiq Dialogue — with particular emphasis on local leadership, ethics and safety, experiential learning, and continuity. Our intention is to help others evaluate the opportunities and limitations of land camps for their own community context and research questions. Inuit tama’nganituqaq ilihaivalau’mata nunamii’lutik. Ublumiuřuq Inuit nunaa’ni humituinnaq nunami ilihainahualiqpaktut nunamiinirmik, inuuhirmi’nik i&uaqhinahuaq&-utiglu qauřimanirmi’nik tunihinahuaq&utik nutaqqami’nut qablunaaqaliraluaqti’lugu Inuktut ilihattiaruiralua’mata. Qauřihaqtit taapkuat hanaqatiqaq&utik inutuqarnik Uqšuqtuurmiutarnik Nunavummi, nalunaiqhittiarahuaq&utik tuktut inuuhuqattiarutauni-ngi’nik, inutuqallu nunami katiqatigiiquři’lutik i&uarniqšaittuu’mat: inutuqarnut ta’na ilihaqtami’nik ilihaijuma’lutik, inuuhuktullu ilihattiatqiřaujungna’mataguuq, qauřihaqtillu ta’na qauřihattiatqijaujungna’mata atuutiqaqtunik inungnut. Atuqtut malik&utik qařginnguarmik pivaallirutaunahuaqtumik atuqtauvaktumik atu’magit, malik&utiglu katimařiralaat inuit pitquřai’nik, pingahuiqtiq&utik nunami katiqatigiingniqaralua’mata ukiut 2011-mit 2013-mut. Taamnalu qařginnguaq atuqtauvaktuq titiraqtauhimařuq nalunaiqhihima’mat iluani qanuq qapblunaat pittiarahuarniqšaujungnariakšaita qauřihaqti’lugit inuit pitquhiagut i&uatqiřauřumik. Tařvani titiraqtut unipkaaq&utik ilaagut atqunarnia’nik pittiarahuaq&utik ilitquhiqaqatigiinngiti’lugit – inuuqatigiigahuaq&utik qařgiqaqatigiiktutut ukunanik atuutikhaqarahuaq&utik hanařut: taamna qauřiharniq inungnit aulatau’luni, pittiarnirlu qanurinnginnirlu ihumagiřauřut, nunami ilihaq&utik, kajuhiinnarungnaqtumik aturahuaq&utik atuutiqaqtunik inungnut. Qauřihaqtit tařvani unipkaaqtut atuqtami’nik ikajurniqaqu’lugu ahiinut nunami ilihaqtittinahuaqtunut ima’natut hanalutik, atuutiqattiarnia’niglu atqunarnarnia’niglu ilaagut, ahiit na’miniq hanajumagutik nunami’ni qauřihaqrumagutik ima’natut pijungna’mata.

The Institute of Community in The Works of N.I. Sieber

This article examines the views of the Russian economist Nikolai Ivanovich Sieber on community relations both in Russia and abroad. Sieber, as is known, is the first Russian follower of Marx, who assimilated his theory in all its complexity and dialectical inconsistency. However, in this article, the main attention is paid to the position of Sieber in relation to the peasant community. If Sieber was a consistent apologist for Marx's theory, without introducing his own ideas into it, then scholar seems to be completely independent with his own point of view in matters of the community. In the community context, he argued with the narodniks, particularly with V. P. Vorontsov, about the ways of developing the Russian economy. Should it develop based on the preservation and development of the peasant community, artels, as opposed to the creation of large-scale capitalist production in Russia, or should the country strive to create a capitalist economy in which there is no place for community relations? Sieber refuted the narodnik concept of a special way of development of Russia and defended the Marxist idea that capitalism is an objective stage in the development of society and, therefore, inevitable.

Barriers to hepatitis C diagnosis and treatment in the DAA era: Preliminary results of a community-based survey of primary care practitioners

Notwithstanding the groundbreaking achievement of hepatitis C curative treatment with direct acting antiviral therapies, Canada faces an uphill battle in reaching the 2030 goal of viral elimination set forth the by the World Health Organization, a goal made more difficult by the COVID-19 pandemic. There is limited understanding of the diagnostic and treatment barriers, and challenges in linkage to care in Canada, especially as it pertains to primary care providers in a community context. Therefore, in this article, the authors conducted a survey study to evaluate the following factors: primary care providers’ knowledge of specialist treatment options and the importance of screening and treatment; and patient factors, including transportation, linguistic barriers, and other socio-economic status indicators that impact the screening and management of hepatitis C. The results suggest that public health campaigns that protocolize and/or incentivize screening and referrals may provide solutions to addressing such barriers.

Bilingual language development in infancy: What can we do to support bilingual families?

Many infants and children around the world grow up exposed to two or more languages. Their success in learning each of their languages is a direct consequence of the quantity and quality of their everyday language experience, including at home, in daycare and preschools, and in the broader community context. Here, we discuss how research on early language learning can inform policies that promote successful bilingual development across the varied contexts in which infants and children live and learn. Throughout our discussions, we highlight that each individual child’s experience is unique. In fact, it seems that there are as many ways to grow up bilingual as there are bilingual children. To promote successful bilingual development, we need policies that acknowledge this variability and support frequent exposure to high-quality experience in each of a child’s languages.

On eco-evolutionary dynamics of phenologies in competitive communities and their robustness to climate change

Global changes currently cause temporal shifts in the favourable conditions for different phases of species life cycles. Phenologies characterizing temporal presence, may adapt through heritable evolution in response to these changes. Given a community context, this evolution may cause a change in the phenology overlap and thus a change of interspecific interactions such as competition. Using a model in which phenologies compete and coevolve, we study the conditions under which diversity emerges, as well as their annual distribution. We find that the environment richness (food quantity, light, pollinators, etc) and competition constrain the diversity and spread of phenologies. A robust pattern of phenologies distribution emerges consistent with Swedish flowering observations. Once a stable community is reached, we apply a progressive change in environmental conditions. We found that adaptation eventually restored diversity, but that the simulated change often led to numerous extinctions due to increased competition. The percentage of diversity lost depends on the speed of change and on the initial diversity. Phenologies already pre-adapted to the new environmental conditions drive the restoration of diversity after the change. We finally study a spatial version of the model in which local communities are organized along an environmental gradient. Pre-change, allowing dispersal decreases the local adaptation of phenologies to their local fixed environmental conditions. Dispersal however largely enhances the maintenance of biodiversity in changing environments, though its benefits are not homogeneous in space. Evolution remains the only rescue mechanism for southern phenotypes.

Influence of Social Determinants on Self-Rated Health in Three Countries of East Asia

This study aims to compare five domains of social determinants and their associations with self-rated health (SRH) among older adults in China, Japan, and Korea, where they share some cultural values but the development and conditions of economic status, health care system, and education system vary. A total of 10,111 participants aged 65 years and older were included from three harmonized datasets at baseline CHARLS, KLoSA, and JSTAR. Guided by the Healthy People 2020 Framework, five domains of social determinants were included: education levels, economic stability (total income, working for pay), social and community context (social engagement, living with children), health care access (medical center utilization), and neighborhood (rural vs. urban). Regression models showed that working for pay, social engagement, and medical center utilization were significant predictors for SRH in three countries. However, unique predictors have also been observed in China and Korea, which will be discussed in the presentation.

Using Ecological and Twitter-Based Assessments to Examine Impacts in Temporal and Community Context

In March 2020, Bronx County (NY) saw one of the first U.S. COVID-19 outbreaks. This outbreak coincided with the ongoing Einstein Aging Study (EAS), which involved older adults living in Bronx County completing annual two-week intensive data collection “bursts.” Thus, it serves as a natural experiment to study pre-COVID to early pandemic-related changes in the daily well-being of participants who were at risk both due to their age and their location. We examined within-person change in self-reported negative thoughts, affect, stress, and loneliness from a subsample of 78 EAS participants. Participants’ data from a two-week “burst” of momentary surveys during 2019 were compared with their data from the corresponding timeframe during the early COVID-19 period (February-June 2020). Personality and mild cognitive impairment were examined as predictors of change. Average momentary loneliness significantly increased from 2019 to 2020. Participants with greater neuroticism increased more in thought unpleasantness and depressed feelings. To understand the community context, community distress markers were analyzed using Artificial Intelligence (AI)-based assessments of public Twitter posts from Bronx County during the same periods. These Twitter posts also showed a surge of COVID-related topics at the onset of the Bronx outbreak. Language analysis showed a 2019-2020 increase in Bronx community markers of anxiety, depressivity, and negatively-valenced affect extracted from Twitter. We observed 2019-2020 change in both individuals’ well-being (via intensive reports) and in their communities (via Twitter). Contextualizing these with the increased COVID-19 discussion online suggests that these may reflect common pandemic effects.

On pandemics and pivots: a COVID-19 reflection on envisioning the future of medical education

The required adjustments precipitated by the coronavirus disease 2019 crisis have been challenging, but also represent a critical opportunity for the evolution and potential disruptive and constructive change of medical education. Given that the format of medical education is not fixed, but malleable and in fact must be adaptable to societal needs through ongoing reflexivity, we find ourselves in a potentially transformative learning phase for the field. An Association for Medical Education in Europe ASPIRE Academy group of 18 medical educators from seven countries was formed to consider this opportunity, and identified critical questions for collective reflection on current medical education practices and assumptions, with the attendant challenge to envision the future of medical education. This was achieved through online discussion as well as asynchronous collective reflections by group members. Four major themes and related conclusions arose from this conversation: Why we teach: the humanitarian mission of medicine should be reinforced; what we teach: disaster management, social accountability and embracing an environment of complexity and uncertainty should be the core; how we teach: open pathways to lean medical education and learning by developing learners embedded in a community context; and whom we teach: those willing to take professional responsibility. These collective reflections provide neither fully matured digests of the challenges of our field, nor comprehensive solutions; rather they are offered as a starting point for medical schools to consider as we seek to harness the learning opportunities stimulated by the pandemic.