Reimagining cross-sector collaborations post-pandemic to optimize care for vulnerable homebound older adult populations.
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ABSTRACT:
SUBMITTER: Lee JL
PROVIDER: S-EPMC9283314 | biostudies-literature | 2022 Jul
REPOSITORIES: biostudies-literature
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Reimagining cross-sector collaborations post-pandemic to optimize care for vulnerable homebound older adult populations.
Lee Jessica L JL Gustavson Allison M AM Kian Leslie L Cominsky Martin M Dyer Carmel B CB
Journal of the American Geriatrics Society 20220427 7
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Project description:ObjectivesThe objective of this study is to develop a practice-orientated partnership framework that can enable effective population health collaborations in rural areas, and to gain ground insights on the role and policies of the Department of Families, Fairness and Housing (DFFH) in administering population health projects.Study designRapid evidence review and case study interviews with stakeholders.MethodsThe framework development started with a rapid review to identify evidence-based practices on collaboration for population health stakeholders. Best-practices from DFFH's policy document for place-based projects were also incorporated into the framework. After a preliminary draft of the framework was ready, semi-structured interviews were conducted with stakeholders to seek practitioner insights to validate the framework and contextualise it to local needs.ResultsInputs from the stakeholder interviews were organised into two categories: "Inputs for framework" which contained responses that improved the framework, and "inputs for DFFH" which contained insights on the role and policies of DFFH in administering population health projects.ConclusionsWith its list of actionable activities and enablers organised into logical project phases, the framework provides a practical and intuitive guide that can help stakeholders navigate through complex place-based population health projects. The inputs for DFFH provided the department with valuable ground insights into the dynamics of cross-sector collaborations for further reflection about their roles and policies. Through the consultative interview process which meaningfully engaged key stakeholders, a level of understanding and support for the framework was gained, which would encourage future implementations of place-based population health projects.
| S-EPMC9773052 | biostudies-literature
Project description:AimWhile accumulating evidence suggests that people modified their smoking during the ongoing COVID-19 pandemic, it remains unclear whether those most at risk for tobacco-related health disparities did so. The current study examined changes in smoking among several vulnerable smoker populations during the COVID-19 pandemic.MethodsA web-based survey was distributed in 2020 to 709 adults with socioeconomic disadvantage, affective disorders, or opioid use disorder who participated in a previous study investigating the effects of very low nicotine content (VLNC) cigarettes on smoking. Current smoking status and rate, and adoption of protective health behaviors in response to the pandemic (eg social distancing, mask wearing) were examined.ResultsAmong 332 survey respondents (46.8% response rate), 84.6% were current smokers. Repeated measures ANOVA showed that current cigarettes/day (CPD) was higher during COVID than pre-COVID (12.9 ± 1.0 versus 11.6 ± 1.0; p < .001). Most respondents had adopted protective health behaviors to prevent infection (>79% for all behaviors). More than half indicated that they were still leaving their homes specifically to buy cigarettes (64.6%) and were buying more packs per visit to the store (54.5%) than pre-COVID. Individuals unemployed at the time of the survey experienced greater increases in CPD (from 11.4 ± 1.4 to 13.3 ± 1.4, p = .024) as did those with higher levels of anxiety (from 11.5 ± 1.1 to 13.6 ± 1.1, p < .001).ConclusionsSmoking increased during the COVID-19 pandemic in this sample of adults from vulnerable populations, even while most adopted protective health measures to prevent infection. Unemployment and anxiety might identify those at greatest risk for increases in tobacco use.ImplicationsIndividuals from populations especially vulnerable to smoking might be at risk for greater harm from cigarette smoking during times of pandemic-related stress. Public health interventions are warranted to ameliorate increases in smoking among these populations. Special attention should be paid to those experiencing unemployment and high anxiety.
| S-EPMC9384158 | biostudies-literature
Project description:BackgroundMore than half of persons living with HIV (PLWH) in the United States are insufficiently engaged in HIV primary care and not taking antiretroviral therapy (ART), mainly African Americans/Blacks and Hispanics. In the proposed project, a potent and innovative research methodology, the multiphase optimization strategy (MOST), will be employed to develop a highly efficacious, efficient, scalable, and cost-effective intervention to increase engagement along the HIV care continuum. Whereas randomized controlled trials are valuable for evaluating the efficacy of multi-component interventions as a package, they are not designed to evaluate which specific components contribute to efficacy. MOST, a pioneering, engineering-inspired framework, addresses this problem through highly efficient randomized experimentation to assess the performance of individual intervention components and their interactions. We propose to use MOST to engineer an intervention to increase engagement along the HIV care continuum for African American/Black and Hispanic PLWH not well engaged in care and not taking ART. Further, the intervention will be optimized for cost-effectiveness. A similar set of multi-level factors impede both HIV care and ART initiation for African American/Black and Hispanic PLWH, primary among them individual- (e.g., substance use, distrust, fear), social- (e.g., stigma), and structural-level barriers (e.g., difficulties accessing ancillary services). Guided by a multi-level social cognitive theory, and using the motivational interviewing approach, the study will evaluate five distinct culturally based intervention components (i.e., counseling sessions, pre-adherence preparation, support groups, peer mentorship, and patient navigation), each designed to address a specific barrier to HIV care and ART initiation. These components are well-grounded in the empirical literature and were found acceptable, feasible, and promising with respect to efficacy in a preliminary study.Methods/designStudy aims are: 1) using a highly efficient fractional factorial experimental design, identify which of five intervention components contribute meaningfully to improvement in HIV viral suppression, and secondary outcomes of ART adherence and engagement in HIV primary care; 2) identify mediators and moderators of intervention component efficacy; and 3) using a mathematical modeling approach, build the most cost-effective and efficient intervention package from the efficacious components. A heterogeneous sample of African American/Black and Hispanic PLWH (with respect to age, substance use, and sexual minority status) will be recruited with a proven hybrid sampling method using targeted sampling in community settings and peer recruitment (N = 512).DiscussionThis is the first study to apply the MOST framework in the field of HIV prevention and treatment. This innovative study will produce a culturally based HIV care continuum intervention for the nation's most vulnerable PLWH, optimized for cost-effectiveness, and with exceptional levels of efficacy, efficiency, and scalability.Trial registrationClinicalTrials.gov, NCT02801747 , Registered June 8, 2016.
| S-EPMC5418718 | biostudies-literature
Project description:Populations in post-conflict settings often have increased healthcare needs, residing in settings where basic services needed to maintain good health may be non-existent or hard to access. Therefore, there is a need for better identification and reallocation of resources as part of the post-conflict health rehabilitation effort. Assets can be described as the collective resources that individuals and communities have at their disposal, which protect against adverse health outcomes and promote health status. This study applies an asset-based approach to explore the most optimal design of health services and to identify the resource constraints for basic health service delivery to the most vulnerable communities in eastern Congo. We implemented the asset mapping in two phases. Firstly, we combined a qualitative survey with community walks to identify the assets already present in the communities. Secondly, we conducted group discussions to map out assets that are the core of asset-based community development (ABCD) practice. We finally documented all assets in a Community Asset Spreadsheet. Overall, 210 assets were identified as available and potentially valuable resources for the communities in eastern Congo. Among them, 57 were related to local associations, 23 to land and physical environments, 43 to local institutions, 46 to individuals, 35 to economy and exchange, and only 6 to culture, history, and stories. Drawing upon the findings of the qualitative survey, community walks, and group discussions, we concluded that an important number of resources are in place for basic health service delivery. By activating existing and potential resources, the most vulnerable populations in eastern Congo might have the required resources for basic health service delivery. Our findings support the use of an asset-mapping research method as appropriate for identifying existing and potential resources for basic health services in a post-conflict setting.
| S-EPMC10606858 | biostudies-literature
Project description:OBJECTIVES:This study examines types and forms of cross-sector collaborations employed by rural communities to address community health issues and identifies factors facilitating or inhibiting such collaborations. SETTING:We conducted case studies of four rural communities in the US state of Iowa that have demonstrated progress in creating healthier communities. PARTICIPANTS:Key informants from local public health departments, hospitals and other health-promoting organisations and groups participated in this study. Twenty-two key-informant interviews were conducted. Participants were selected based on their organisation's involvement in community health initiatives. RESULTS:Rural communities used different forms of collaborations, including cross-sector partnership, cross-sector interaction and cross-sector exploration, to address community health issues. Stakeholders from public health, healthcare, social services, education and business sectors were involved. Factors facilitating cross-sector collaborations include health-promoting local contexts, seed initiatives that mobilise communities, hospital visions that embrace broad views of health and shared collaboration leadership and governance. Challenges to developing and sustaining cross-sector collaborations include different institutional logics, financial and human resources constraints and geographic dispersion. CONCLUSIONS:Rural communities use cross-sector collaborations to address community health issues in the forms of interaction and exploration, but real and lasting partnerships are rare. The development, operation and sustainment of cross-sector collaborations are influenced by a set of contextual and practical factors. Practical strategies and policy interventions may be used to enhance cross-sector collaborations in rural communities.
| S-EPMC6858126 | biostudies-literature
Project description:BackgroundBrazil has been dramatically hit by the SARS-CoV-2 pandemic and is a world leader in COVID-19 morbidity and mortality. Additionally, the largest country of Latin America has been a continuous source of SARS-CoV-2 variants and shows extraordinary variability of the pandemic strains probably related to the country´s outstanding position as a Latin American economical and transportation hub. Not all regions of the country show sufficient infrastructure for SARS-CoV-2 diagnosis and genotyping which can negatively impact the pandemic response.MethodsDue to this reason and to disburden the diagnostic system of the inner São Paulo State, the Butantan Institute established the Mobile Laboratory (in Portuguese: LabMovel) for SARS-CoV-2 testing which started a trip of the most important "hotspots" of the most populous Brazilian region. The LabMovel initiated in two important cities of the State: Aparecida do Norte (an important religious center) and the Baixada Santista region which incorporates the port of Santos, the busiest in Latin America. The LabMovel was fully equipped with an automatized system for SARS-CoV-2 diagnosis and sequencing/genotyping. It also integrated the laboratory systems for patient records and results divulgation including in the Federal Brazilian Healthcare System.ResultsCurrently,16,678 samples were tested, among them 1,217 from Aparecida and 4,564 from Baixada Santista. We tracked the delta introductio in the tested regions with its high diversification. The established mobile SARS-CoV-2 laboratory had a major impact on the Public Health System of the included cities including timely delivery of the results to the healthcare agents and the Federal Healthcare system, evaluation of the vaccination status of the positive individuals in the background of exponential vaccination process in Brazil and scientific and technological divulgation of the fieldwork to the most vulnerable populations.ConclusionsThe SARS-CoV-2 pandemic has demonstrated worldwide the importance of science to fight against this viral agent and the LabMovel shows that it is possible to integrate researchers, clinicians, healthcare workers and patients to take rapid actions that can in fact mitigate this and other epidemiological situations.
| S-EPMC9810251 | biostudies-literature
Project description:Workplaces are nodes for Severe Acute Respiratory Syndrome Coronavirus 2 transmission and require strategies to protect workers' health. This article reports on the South African national coronavirus disease 2019 (COVID-19) strategy that sought to ensure workers' health, protect the economic activity, safeguard livelihoods and support health services. Data from the Occupational Health Surveillance System, Surveillance System of Sentinel Hospital Sites, and government databases (public sector health worker and Compensation Fund data) was supplemented by peer-reviewed articles and grey literature. A multipronged, multi-stakeholder response to occupational health and safety (OHS) policy development, risk management, health surveillance, information, and training was adopted, underpinned by scientific input, through collaboration between government, organized labour, employer bodies, academia, and community partners. This resulted in government-promulgated legislation addressing OHS, sectoral guidelines, and work-related COVID-19 worker's compensation. The OHS Workstream of the National Department of Health provided leadership and technical support for COVID-specific workplace guidelines and practices, surveillance, information, and training, as well as a workplace-based vaccination strategy.
| S-EPMC9852971 | biostudies-literature
Project description:University students are predisposed to stress, which could be even higher in Nursing students since they are directly related to the COVID-19 pandemic given their health training and area of knowledge. Our purpose was to assess the stress levels of Nursing students before and during lockdown due to the COVID-19 pandemic in Murcia (Spain), its influence on taking an online exam and how it was affected by physical exercise. This was an observational and prospective study including Nursing students from the second year of the Nursing Degree from 3 February to 23 April 2020. Three measurements were performed: one before lockdown and two during lockdown. Stress increased substantially during lockdown. Financial, family or emotional problems, as well as physical exercise, also increased. Indeed, at 40 days of lockdown, those students with financial, family or emotional problems, and less physical exercise reported significantly higher stress levels. In addition, those who passed the online exam had lower stress levels compared to those who failed. In conclusion, during lockdown, stress in Nursing students increased. This could be triggered by students' personal problems, and physical exercise may be used as a way to reduce stress. Academic performance was better in those students reporting less stress.
| S-EPMC7600682 | biostudies-literature
Project description:BackgroundHomebound older adults have heightened risks for isolation and negative health consequences, but it is unclear how COVID-19 has impacted them. We examine social contact and mood symptoms among previously homebound older adults during the COVID-19 pandemic.Design/settingCross-sectional analysis using data from the National Health and Aging Trends Study (NHATS), a nationally-representative longitudinal study of aging in the USA.ParticipantsA total of 3,112 community-dwelling older adults in 2019 who completed the COVID-19 survey in the summer/fall of 2020.MeasurementsHomebound status was defined via self-report as rarely/never leaving home or leaving the house with difficulty or help in the prior month. We measured limited social contact during COVID-19 (in-person, telephone, video or email contacts <once/week), as well as loneliness, anxiety, and depression.ResultsAmong homebound older adults, 13.2% experienced limited social contact during COVID-19 vs. 6.5% of the non-homebound. Differences in social contact were greatest for contacts via email/text/social media: 54.9% of the homebound used this <once/week vs. 28.4% of the non-homebound. In adjusted analyses of those without limited social contact prior to the pandemic, the homebound had higher but not significantly different odds (OR 1.83; 95% CI 0.95-3.52) of limited social contact during COVID-19, with increased risk among the older individuals, those with dementia, and those in assisted living facilities. Of the homebound, 13.2% felt lonely every/most days during the pandemic vs. 7.7% of non-homebound older adults. Homebound and non-homebound older adults reported similar rates of increased loneliness, anxiety, or depression during COVID-19. Fewer homebound older adults learned a new technology during the pandemic (16.3%) vs. non-homebound older adults (30.4%).DiscussionIsolation among homebound older adults increased during COVID-19, partially due to differences in technology use. We must ensure that homebound persons have the connection and care they need including new technologies for communication during and beyond COVID-19.
| S-EPMC8853401 | biostudies-literature
Project description:BackgroundThe COVID-19 pandemic strained healthcare systems around the world. This study aims to understand the preparedness of private remote hospitals in Lebanon to respond to the pandemic and evaluate the impact of inter-hospital collaborations on the hospitals' readiness.MethodsA multi-centered study was conducted between August 2020 and June 2021 in ten Lebanese private remote hospitals based on a mixed-methods embedded approach where the quantitative supported the qualitative. Through the AUB-USAID (American University of Beirut-United States Agency for International Development) COVID-19 project, these hospitals received personal protective equipment and medical equipment in addition to COVID-19-related training using the Train-the-Trainer model. The quantitative part used knowledge and evaluation questionnaires and a pre-post-intervention hospital preparedness checklist. The qualitative approach adopted semi-structured interviews with a purposive sample from key hospital personnel. Quantitative data were analyzed using SPSS version 27, and a p-value of <0.05 was considered to be statistically significant. For the qualitative data, a thematic analysis was performed by adopting the six-phase process described by Braun and Clarke.ResultsOf the 393 healthcare workers who attended the training and completed the evaluation questionnaire, 326 completed the pre- and post-training knowledge questionnaire. A significant improvement was observed in mean knowledge scores following training for infection control, nursing, and polymerase chain reaction sampling staff (p-value < 0.001, p-value < 0.001, and p-value = 0.006, respectively), but not for housekeeping staff. More than 93% of the participants showed high trainer and content evaluation scores. As for the hospitals' preparedness assessments, there was a clear improvement in the pre- and post-assessment scores for each hospital, and there was a significant difference in the mean of the total scores of partner hospitals pre- and post-USAID-AUB project (p-value = 0.005). These findings were supported by the qualitative analysis, where nine hospitals expressed the positive impact of the USAID-AUB intervention in improving their preparedness to respond to the COVID-19 pandemic at a critical time when it was highly needed. Despite the intervention, persistent challenges remained.ConclusionsA timely and proactive collaborative program between academic/tertiary care centers and remote community hospitals that includes sharing supplies and expertise is feasible and highly effective during public health emergencies.
| S-EPMC10855495 | biostudies-literature