Shifting gender norms to improve HIV service uptake: Qualitative findings from a large-scale community mobilization intervention in rural South Africa

Background Interventions to improve HIV service uptake are increasingly addressing inequitable and restrictive gender norms. Yet comparatively little is known about which gender norms are most salient for HIV testing and treatment and how changing these specific norms translates into HIV service uptake. To explore these questions, we implemented a qualitative study during a community mobilization trial targeting social barriers to HIV service uptake in South Africa. Methods We conducted 55 in-depth interviews in 2018, during the final months of a three-year intervention in rural Mpumalanga province. Participants included 25 intervention community members (48% women) and 30 intervention staff/community-opinion-leaders (70% women). Data were analyzed using an inductive-deductive approach. Results We identified three avenues for gender norms change which, when coupled with other strategies, were described to support HIV service uptake: (1) Challenging norms around male toughness/avoidance of help-seeking, combined with information on the health and preventive benefits of early antiretroviral therapy (ART), eased men’s fears of a positive diagnosis and facilitated HIV service uptake. (2) Challenging norms about men’s expected control over women, combined with communication and conflict resolution skill-building, encouraged couple support around HIV service uptake. (3) Challenging norms around women being solely responsible for the family’s health, combined with information about sero-discordance and why both members of the couple should be tested, encouraged men to test for HIV rather than relying on their partner’s results. Facility-level barriers such as long wait times continued to prevent some men from accessing care. Conclusions Despite continued facility-level barriers, we found that promoting critical reflection around several specific gender norms, coupled with information (e.g., benefits of ART) and skill-building (e.g., communication), were perceived to support men’s and women’s engagement in HIV services. There is a need to identify and tailor programming around specific gender norms that hinder HIV service uptake.

Technology-Driven Dyadic Interaction Support for Community-Dwelling People With Dementia and Family Caregivers

People with dementia and their family caregivers struggling with the impacts of the condition on cognitive abilities, experience deterred social interactions and strained relationships. Technology can potentially sustain the relationship by engaging dyads in joint activities and supporting their interaction. This study aimed to evaluate the impact of a tablet-based activation system, I-CARE, specifically designed to engage people with dementia in meaningful activities. In this intervention, community-dwelling people with dementia and their family caregiver engaged in joint activities supported by the I-CARE system. Quantitative measures on quality of life, relationship quality and caregiver burden are collected, while semi-structured interviews explore the impact of Covid-19, as well as what motivates the participants to invite technology into their dyadic interactions. Our findings provide important insight in how technology can support social health and relationship sustenance of dyads living with dementia, and what implications Covid-19 has for their social participation in society.

Penyuluhan Kesehatan Konsumsi Buah dan Sayur di Rw 003 Kelurahan Benda Baru Pamulang Sebagai Upaya Pencegahan Tuberkolosis

Di Indonesia pemberantasan penyakit tuberkulosis telah dimulai sejak tahun 1950 dan sesuai rekomendasi WHO sejak tahun 1986 regimen pengobatan yang semula 12 bulan diganti dengan pengobatan selama 6-9 bulan. Pemerintah sudah sangat serius memperhatikan masalah TBC, dengan memberikan bantuan berupa pemberian obat TBC secara gratis. Namun faktanya, efektifitas pengobatan yang dilakukan oleh penderita TBC masih rendah. Tingkat kesembuhan penderita tuberkulosis adalah sebesar 85,30%, dengan tingkat kesukaan buah sebanyak 84%. Namun intensitas responden dalam mengkonsumsi buah hanya sebesar 68% dan tingkat konsumsi buah hanya sebesar 65,30%, serta tingkat keteraturan konsumsi buah saat menderita tuberkulosis hanya sebesar 67,30%. Berdasarkan hasil Musyawarah Masyarakat Desa, masyarakat sepakat untuk memilih TBC untuk menjadi acuan intervensi program. Pengabdian Masyarakat yang dilakukan dalam bentuk penyuluhan ini mengangkat tema “Ayo Konsumsi Buah dan Sayur untuk Putus Tali Penularan TBC.” Penyuluhan kesehatan ini dilaksanakan pada hari Sabtu, 15 Februari 2020 di Mushola AR-Rahman RT 04 RW 003. Dihadiri oleh 30 orang terdiri dari lapisan masyarakat dari RW 003 Kelurahan Benda Baru. Berdasarkan hasil perhitungan pre-test dan post-test, didapatkan bahwa ada peningkatan pengetahuan masyarakat terkait manfaat buah dan sayur untuk penyakit Tuberkolosis antara sebelum dan setelah diberikan penyuluhan. Disarankan agar kebiasaan maka buah dan sayur bisa menjadi kebiasaan di tengan masyarakat.---In Indonesia the eradication of tuberculosis has been started since 1950 and according to WHO recommendations since 1986 the treatment regimen that was originally 12 months replaced with treatment for 6-9 months. The government has been very serious about paying attention to the TBC problem, by providing assistance in the form of giving free TBC medicines. But in fact, the effectiveness of treatment carried out by people with TBC is still low. It was found that the cure rate of tuberculosis patients was 85.30%, with a fruit preference rate of 84%. But the intensity of respondents in consuming fruit was only 68% and the level of fruit consumption was only 65.30%, and the level of regularity of fruit consumption when suffering from tuberculosis was only 67.30%. Based on the results of the Village Community Conference, the community agreed to choose TBC as a reference for program intervention. Community Service is carried out in the form of counseling with the theme "Let's Eat Fruits and Vegetables to Break the Rope of TBC Transmission." This health education was held on Saturday, February 15, 2020 at Mushola AR-Rahman RT 04 RW 003. Attended by 30 people consisting of people from RW 003 Benda Baru Village. Based on the results of the pre-test and post-test calculations, it was found that there was an increase in community knowledge related to the benefits of fruits and vegetables for tuberculosis between before and after counseling. It is suggested that the habbit of fruit and vagetables can become a habit among the people.

EFFECTIVENESS OF COMMUNITY-BASED HEALTH EDUCATION ON PREPAREDNESS FOR FLOOD-RELATED COMMUNICABLE DISEASES IN KELANTAN

The flood disaster in Kelantan in 2014 had resulted in substantial health implications including increased cases of communicable diseases. There was a lack of community preparedness including customized health educations in the prevention and control of flood-related communicable diseases in the affected areas. The research was aimed to evaluate the effectiveness of community-based health education modules on flood-related communicable diseases among communities in Kelantan. Health education modules focusing on major food-related diseases were developed. A non-randomized community-controlled trial using the modules were conducted. Outcomes were assessed on knowledge, attitude and preventive practice scores to flood-related communicable diseases using a pre-validated questionnaire. Independent t test was used to compare mean scores between the intervention community (Tumpat) and the control community (Bachok) at 1-month post intervention. One-way independent ANOVA test was done to compare score differences at baseline (pre), post 1-month and post 2-month from repeated surveys among random samples within the intervention community. There were significant improvements in all knowledge components from 9.4% to 52.6% with 10% increment in attitude scores toward preventing behaviours on flood-related communicable diseases. When compared against the control community at one-month post-intervention, there were significantly higher knowledge on types of diseases, symptoms and risk factors as well as practice scores of drinking safe water and protective habits. This research demonstrated that community-based health education is effective in improving relevant knowledge, attitude and preventive practices among affected communities as part of their preparedness toward communicable diseases related to flood.

Use of Telemedicine for Emergency Triage in an Independent Senior Living Community: Mixed Methods Study

Background Older, chronically ill individuals in independent living communities are frequently transferred to the emergency department (ED) for acute issues that could be managed in lower-acuity settings. Triage via telemedicine could deter unnecessary ED transfers. Objective We examined the effectiveness of a telemedicine intervention for emergency triage in an independent living community. Methods In the intervention community, a 950-resident independent senior living community, when a resident called for help, emergency medical technician–trained staff could engage an emergency medicine physician via telemedicine to assist with management and triage. We compared trends in the proportion of calls resulting in transport to the ED (ie, primary outcome) in the intervention community to two control communities. Secondary outcomes were telemedicine use and posttransport disposition. Semistructured focus groups of residents and staff were conducted to examine attitudes toward the intervention. Qualitative data analysis used thematic analysis. Results Although the service was offered at no cost to residents, use was low and we found no evidence of fewer ED transfers. The key barrier to program use was resistance from frontline staff members, who did not view telemedicine triage as a valuable tool for emergency response, instead perceiving it as time-consuming and as undermining their independent judgment. Conclusions Engagement of, and acceptance by, frontline providers is a key consideration in using telemedicine triage to reduce unnecessary ED transfers.

Factors affecting successful scale-up of health-related pilot projects

Objective: To identify the key factors that contribute to the successful scale-up of pilot projects, with emphasis on factors that are proven helpful in the successful scaling up of health interventions. Methods: Grey literature was searched at the library of the University of Kebangsaan, Malaysia, on database engines Google Scholar and Science Direct with specific key words to screen papers published from January 2001 to June 2016. They were reviewed to identify the key factors affecting scaling up of health-related pilot projects. Full-text articles were selected, and their reference lists were checked to look for relevant papers. They were short-listed and analysed using thematic approach. Results: Of the 47 articles initially screened, 14(29.78%) were shortlisted. Thematic analysis of the selected articles suggested several key factors contributed to the successful scale-up of pilot projects. These factors included evidence-based and effective intervention, community readiness, Continuous....

Outcomes of a Community-Wide Health Intervention in a Low-Income, Primarily Hispanic Community: The Go! Austin/Vamos! Austin (GAVA) Initiative

Objectives To describe outcomes of a 4-year physical activity (PA) and nutrition intervention (2013–2017) in Dove Springs, a low-income urban community in Texas. Method Go! Austin/Vamos! Austin is a place-based intervention targeting the built and social environments of PA and nutrition. Baseline and follow-up measures related to PA and nutrition were obtained from 357 parent–child dyads (final n = 236) in the intervention community and a control community. A three-level dose of exposure measure was created to indicate the amount of exposure to intervention activities across the 4 years. Pre–post changes in key outcomes by level of exposure and contrasts across “high exposure” and “no exposure” categories were obtained using repeated-measures regression, adjusting for important confounders. Results “High exposure” adult participants showed consistently more favorable changes than “no exposure” participants across a variety of indicators, including positive perceptions and utilization of community PA resources, amount of moderate PA, utilization of retail outlets offering fresh produce, and measures of healthy eating. Few improvements were seen in child-level outcomes. Conclusions Community interventions can successfully improve health-promoting behaviors provided they ensure sufficient dose of exposure.

Use of Telemedicine for Emergency Triage in an Independent Senior Living Community: Mixed Methods Study (Preprint)

BACKGROUND Older, chronically ill individuals in independent living communities are frequently transferred to the emergency department (ED) for acute issues that could be managed in lower-acuity settings. Triage via telemedicine could deter unnecessary ED transfers. OBJECTIVE We examined the effectiveness of a telemedicine intervention for emergency triage in an independent living community. METHODS In the intervention community, a 950-resident independent senior living community, when a resident called for help, emergency medical technician–trained staff could engage an emergency medicine physician via telemedicine to assist with management and triage. We compared trends in the proportion of calls resulting in transport to the ED (ie, primary outcome) in the intervention community to two control communities. Secondary outcomes were telemedicine use and posttransport disposition. Semistructured focus groups of residents and staff were conducted to examine attitudes toward the intervention. Qualitative data analysis used thematic analysis. RESULTS Although the service was offered at no cost to residents, use was low and we found no evidence of fewer ED transfers. The key barrier to program use was resistance from frontline staff members, who did not view telemedicine triage as a valuable tool for emergency response, instead perceiving it as time-consuming and as undermining their independent judgment. CONCLUSIONS Engagement of, and acceptance by, frontline providers is a key consideration in using telemedicine triage to reduce unnecessary ED transfers.

Morbidity of in-hospital purulent-septic infections of adults patients after different types of endovascular cardiosurgical operations

An estimate of the incidence of nosocomial purulent-septic infections (GSI) of adult patients after various types of closed heart surgery according to the results of a study of medical records of 3275 patients is presented. It was established that the incidence rate of typical GSI after endovascular cardiac surgery was 3.1, with prenosological forms — 3.9 per 1000 operations. The main clinical options for postoperative GSI were infections in the field of surgical intervention, community-acquired pneumonia, urinary tract infection and bloodstream infection. There were no statistically significant differences between the incidence of GSI after stenting of the coronary arteries, operations for heart rhythm disturbances, stenosis of the carotid artery and other operations. The low incidence of GSI after closed heart surgery is due to the short duration of surgery, as well as the absence or short-term resuscitation of patients.

Examining Changes to Food and Beverage Availability and Marketing in a Low-Income Community after the Opening of a New Supermarket: A Quasi-Experimental Study

Background: In 2016, a large chain supermarket opened in the Englewood community of Chicago, IL – a low-income African American community. The development of this supermarket was supported, in part, by the Healthy Food Financing Initiative (HFFI) – a federal initiative to expand access to healthy foods in food deserts. The aim of this study was to examine changes to food and beverage availability and marketing in Englewood’s existing food stores after the supermarket’s opening. Methods: A quasi-experimental study was conducted from 2016 – 2018. Trained fieldworkers audited all small grocery and limited-service stores (e.g., convenience stores, liquor stores, pharmacies, dollar/discount stores) located within one-square mile of the new supermarket and a one-square mile area of a demographically comparable community in Chicago that also lacked a supermarket. All stores in the one-square mile area were audited at three time points: before (2016) and after (2017 and 2018) the supermarket opened. Extensive data on availability and marketing were collected for staple food items, snacks, and beverages. Difference-in-differences (DID) regression models were used to identify significant differences between the intervention and comparison communities in the changes in food and beverage availability and marketing. Results: Of the 78 stores audited at baseline, 71.8% were limited-service stores, and 85.9% accepted Supplemental Nutrition Assistance Program (SNAP) benefits. The availability of healthy food and beverage options in existing food stores was limited at baseline and both follow-up periods. Stores in the intervention community offered, on average, < 3 fresh vegetable options and < 2 fresh fruit options at all three time periods. DID regression models revealed a significant increase in 1) the percentage of stores in the intervention community offering regular cheese and promoting salty snacks at check-out from 2016 – 2017 and 2) the percentage of stores in the comparison community with interior store promotions for other sweetened beverages from 2016 – 2018. Conclusions: Minimal changes in food and beverage availability and marketing occurred one and two years after the opening of the new supermarket. However, the wide range of staple food items offered by the supermarket expanded healthy food retail in Chicago’s Englewood community.