Using cocreated visually informed community mental health education in low‐ and middle‐income countries: A case study of youth substance misuse in Assam,India

IntroductionOur aim is to evaluate the visually informed community mental health education materials cocreated in our research on youth substance misuse in Assam, India, and to reflect on what we might learn for similar initiatives in low‐ and middle‐income countries.MethodsMaterials consist of: (i) images participants brought to the interview; (ii) 30 posters cocreated by participants to convey key messages from their interview; (iii) six short films on the implications of addiction, and (iv) an animation of our Pathways to Recovery model. We also created a community education package that incorporated these materials. We analyse feedback from three groups of events and a social media campaign, which drew variably across our materials and engaged a range of audiences.ResultsOutcomes indicate the cocreation process and focus on the visual was successful in promoting young people''s voice, increasing awareness and has potential for stigma reduction. Our educational package was deemed useful in increasing awareness and has potential for prevention and treatment.ConclusionsOur case study offers insights into community mental health education in low‐ and middle‐income countries, confirming the importance of cocreation, the usefulness of visual materials and the potential of social media campaigns while acknowledging the importance of local context in health messaging, particularly for stigmatized topics.Patient or Public ContributionService users were involved in the cocreation of the materials evaluated in this study and contributed as presenters in one of the events reported. Members of the public took part in events in which the materials were shared and provided us with the feedback analysed in this article.     

Developing and implementing a targeted health-focused climate communications campaign in Ontario—#MakeItBetter

SettingPublic health practitioners are called to effectively communicate with the public on climate change. The climate crisis requires swift action that starts with public awareness of climate-related health impacts and leads to public support for individual, community and systemic actions to mitigate and adapt to climate change.InterventionThis paper discusses learnings about public opinion research and communication strategies and how a health-focused climate communication campaign—#MakeItBetter—could help to increase awareness and engage new audiences, including public health partners, in conversations about climate change in order to reduce climate-related health impacts for current and future generations. The #MakeItBetter campaign was grounded in evidence-informed messaging, being sensitive to health inequities. Emerging research and pre-campaign testing suggest that framing climate change as a health issue is a promising practice.OutcomesThe #MakeItBetter campaign appeals to parents/caregivers to learn more about climate-related health impacts, take protective action for children and support multi-level climate action. The campaign launch secured 89 news stories, including multicultural media coverage. Longer-term evaluation is required to determine the campaign’s effectiveness in building public support for climate action.ImplicationsAn innovative approach to climate communication that draws on the intersections between behavioural and climate sciences and engages in multi-sectoral collaboration can spur both climate action and health protection, aiding public health practitioners and partners in effectively communicating the urgency for climate action. More work is needed to support communication on climate change as an inequity multiplier and promote climate action and community resilience for health equity co-benefits.     

“Thought I’d Share First” and Other Conspiracy Theory Tweets from the COVID-19 Infodemic: Exploratory Study

BackgroundThe COVID-19 outbreak has left many people isolated within their homes; these people are turning to social media for news and social connection, which leaves them vulnerable to believing and sharing misinformation. Health-related misinformation threatens adherence to public health messaging, and monitoring its spread on social media is critical to understanding the evolution of ideas that have potentially negative public health impacts.ObjectiveThe aim of this study is to use Twitter data to explore methods to characterize and classify four COVID-19 conspiracy theories and to provide context for each of these conspiracy theories through the first 5 months of the pandemic.MethodsWe began with a corpus of COVID-19 tweets (approximately 120 million) spanning late January to early May 2020. We first filtered tweets using regular expressions (n=1.8 million) and used random forest classification models to identify tweets related to four conspiracy theories. Our classified data sets were then used in downstream sentiment analysis and dynamic topic modeling to characterize the linguistic features of COVID-19 conspiracy theories as they evolve over time.ResultsAnalysis using model-labeled data was beneficial for increasing the proportion of data matching misinformation indicators. Random forest classifier metrics varied across the four conspiracy theories considered (F1 scores between 0.347 and 0.857); this performance increased as the given conspiracy theory was more narrowly defined. We showed that misinformation tweets demonstrate more negative sentiment when compared to nonmisinformation tweets and that theories evolve over time, incorporating details from unrelated conspiracy theories as well as real-world events.ConclusionsAlthough we focus here on health-related misinformation, this combination of approaches is not specific to public health and is valuable for characterizing misinformation in general, which is an important first step in creating targeted messaging to counteract its spread. Initial messaging should aim to preempt generalized misinformation before it becomes widespread, while later messaging will need to target evolving conspiracy theories and the new facets of each as they become incorporated.     

A structured community engagement strategy to support uptake of TB active case-finding

BACKGROUND:In Lima, Peru, a mobile TB screening program (“TB Móvil”) was implemented in high TB prevalence districts to increase TB screening. Community engagement activities to promote TB Móvil were simultaneously conducted.OBJECTIVE:To describe a structured, theory-driven community engagement strategy to support the uptake of TB Móvil.METHODS:We adapted Popular Opinion Leader (POL), an evidence-based social networking intervention previously used in Peru to promote HIV testing, for TB Móvil. Community health workers, women who run soup kitchens, and motorcycle taxi drivers served as “popular opinion leaders” who disseminated information about TB Móvil in everyday conversations, aided by a multi-media campaign. Performance indicators of POL included the number/characteristics of persons screened; number of multimedia elements; and proportion of persons with abnormal radiographs hearing about TB Móvil before attending.RESULTS:Between February 2019 and January 2020, 63,899 people attended the TB Móvil program at 210 sites; 60.1% were female. The multimedia campaign included 36 videos, 16 audio vignettes, flyers, posters, community murals and “jingles.” Among attendees receiving an abnormal chest X-ray suggestive of TB, 48% (6,935/14,563) reported hearing about TB Móvil before attending.CONCLUSIONS:POL promotes the uptake of TB Móvil and should be considered as a strategy for increasing TB screening uptake.     

Audiovisual aids in primary healthcare settings’ waiting rooms. A systematic review

Background: Health promotion is part of GPs' commitments. Some waiting rooms have therefore been implemented with audiovisual aids (posters, pamphlets or screens) for health promotion purposes. Few studies have assessed the effect of audiovisual aids in primary care.

Objectives: To identify, describe and appraise studies that have investigated the effects of audiovisual aids on health promotion in primary healthcare waiting rooms. To determine which factors influence this impact through literature review.

Methods: Systematic review. Two independent researchers using predefined keywords searched databases. Additional publications were extracted from the reference lists of the selected articles. The selection of the articles was performed on the title and abstract, followed by complete reading and assessment. Bias and level of evidence were analysed.

Results: A total of 909 articles were collected. Most of them were not in primary care settings. Fourteen peer-reviewed articles fully meeting inclusion criteria were included and analysed. Good quality studies were scarce. Eight of these articles using videos or slideshows on TV screens or tablets indicated effects: three of them were significant on patient knowledge with acceptable evidence and three on health behaviour on surrogate endpoints. Audiovisual aids seem to be used or noticed by patients and can induce conversations with physicians. The relevant factors that might influence these effects (duration of exposure, conception quality, theme, target population and time spent in the waiting room) are insufficiently investigated.

Conclusion: Audiovisual aids broadcasting messages using screens (TVs, computers, tablets, and smartphones with Bluetooth^® pairing) probably enhance patients’ knowledge. A change in health behaviour remains controversial.     

Using healthy community design data to monitor and inform planning and public policy

SettingIn Ontario, Public Health is mandated to work with municipal partners to inform and collaborate on built environment initiatives. For the Healthy Community Design (HCD) Baseline project, Public Health partnered with three communities (approximately 132,000, 29,000 and 22,000 residents, respectively).InterventionThe HCD Baseline Project created a baseline of HCD indicators containing spatial data and self-reported behaviour and perception data. Tailored indicators were determined collaboratively between Public Health and municipal planning staff. Physical HCD indicator data were collected and mapped spatially, while primary data collected from a Neighbourhood Design Survey provided residents’ perceptions of HCD and reported behaviour.OutcomesThe HCD Baseline Project produced a data monitoring system to: track progress of HCD indicators as communities grow; measure current community design to identify municipal and public health priorities, including public policy and supportive environments; and assess the impact of future HCD interventions on the community. By compiling spatial and perception data, areas of strength and opportunity guided the collaborative development of tailored recommendations for each community.ImplicationsFindings from the HCD Baseline Project have created a stronger position for Public Health to support local municipalities. Recommendations are guiding collaborative, evidence-informed initiatives and informing local land use planning and related supportive environment policy. Data collection will be repeated in 5, 10 and 15 years to monitor trends and impact on community design.     

Using Facebook to reach adolescents for human papillomavirus (HPV) vaccination

BackgroundDespite numerous public health campaigns to promote the human papillomavirus (HPV) vaccine, uptake among adolescents in the US has remained below the Healthy People 80% goal for 3-dose completion. The Philadelphia Department of Public Health (PDPH) used an innovative social media strategy to raise awareness and increase rates of HPV immunization initiation and series completion among adolescents.MethodsBetween June 2012 and July 2013, PDPH launched a Facebook campaign to target Philadelphia adolescents (13–18 years) with specific messages about HPV immunization benefits and announce opportunities for vaccination. Six distinct advertising campaigns ran for two-week intervals. Facebook metrics and vaccine clinic data were used to track success. Reminder-recall letters were also sent to adolescents as part of the campaign.ResultsOn average, each advertising campaign reached 155,110 adolescents and engaged 2106 adolescents. The advertising campaigns that focused on HPV disease risk and local resources were the most successful in engaging adolescents. During advertising campaigns, there were sizeable increases in both reach and engagement compared to non-campaign periods. Overall, 3400 adolescents became fans of the campaign and 176 doses of HPV vaccine were administered to 152 adolescents. Only 2 adolescents were vaccinated as a result of the Facebook campaign while the rest were prompted by reminder-recall letters or through community events.ConclusionThe campaign was well-received, far-reaching and generated awareness and conversations among adolescents. However, the campaign did not appear to be a sufficient driver for HPV uptake even when common barriers to HPV immunization were minimized.     

Discourses of masculinity,femininity and sexuality in Uganda’s Stand Proud,Get Circumcised campaign

Abstract

This paper analyses discourses of masculinity, femininity and sexuality in Stand Proud, Get Circumcised, a public health campaign promoting circumcision as an HIV-prevention strategy in Uganda. The campaign includes posters highlighting the positive reactions of women to circumcised men, and is intended to support the national rollout of voluntary medical male circumcision. We offer a critical discourse analysis of representations of masculinity, femininity and sexuality in relation to HIV prevention. The campaign materials have a playful feel and, in contrast to ABC (Abstain, Be faithful, Use condoms) campaigns, acknowledge the potential for pre-marital and extra-marital sex. However, these posters exploit male anxieties about appearance and performance, drawing on hegemonic masculinity to promote circumcision as an idealised body aesthetic. Positioning women as the campaign’s face reasserts a message that women are the custodians of family health and simultaneously perpetuates a norm of estrangement between men and their health. The wives’ slogan, ‘we have less chance of getting HIV’, is misleading, because circumcision only directly prevents female-to-male HIV transmission. Reaffirming hegemonic notions of appearance- and performance-based heterosexual masculinity reproduces existing unsafe norms about masculinity, femininity and sexuality. In selling male circumcision, the posters fail to promote an overall HIV-prevention message.     

Supporting healthy drink choices in remote Aboriginal and Torres Strait Islander communities: a community‐led supportive environment approach

Objective : To create supportive environments to reduce sugary drink consumption and increase water consumption by partnering with remote Aboriginal and Torres Strait Islander communities in Cape York. Methods : This paper applied qualitative and quantitative methods to evaluate a co‐designed multi‐strategy health promotion initiative, implemented over 12 months from 2017 to 2018. Outcome measures included changes in community readiness, awareness of the social marketing campaign and changes in drink availability. Changes in store drink sales were measured in one community and compared to sales in a control store. Results : Community readiness to address sugary drink consumption increased in two of the three communities. Awareness of social marketing campaign messaging was high (56–94%). Availability of drinking water increased in all communities. Water sales as a proportion of total drink volume sales increased by 3.1% (p<0.001) while sugary drink volume sales decreased by 3.4% (p<0.001). Conclusions : A multi‐component strategy with strong engagement from local government, community leaders and the wider community was associated with positive changes in community readiness, drink availability and sales. Implications for public health : Partnering with community leaders in the co‐design of strategies to create environments that support healthy drink consumption can stimulate local action and may positively affect drink consumption.     

Public perspectives on health improvement within a remote‐rural island community

BackgroundRural health outcomes are often worse than their urban counterparts. While rural health theory recognizes the importance of the social determinants of health, there is a lack of insight into public perspectives for improving rural health beyond the provision of health‐care services. Gaining insight into perceived solutions, that include and go beyond health‐ care, can help to inform resource allocation decisions to improve rural health.ObjectiveTo identify and describe shared perspectives within a remote‐rural community on how to improve rural health.MethodUsing Q methodology, a set of 40 statements were developed representing different perceptions of how to improve rural health. Residents of one remote‐rural island community ranked this statement set according to their level of agreement. Card‐sorts were analysed using factor analysis to identify shared points of view and interpreted alongside post‐sort qualitative interviews.ResultsSixty‐two respondents participated in the study. Four shared perspectives were identified, labelled: Local economic activity; Protect and care for the community; Redistribution of resources; and Investing in people. Factors converged on the need to relieve poverty and ensure access to amenities and services.Discussion and conclusionsFactors represent different elements of a multifaceted theory of rural health, indicating that ‘lay’ respondents are capable of comprehending various approaches to health improvement and perspectives are not homogenous within rural communities. Respondents diverged on the role of individuals, the public sector and ‘empowered’ community‐based organizations in delivering these solutions, with implications for policy and practice.Public ContributionMembers of the public were involved in the development and piloting of the statement set.     

Texas Public Agencies’ Tweets and Public Engagement During the COVID-19 Pandemic: Natural Language Processing Approach

BackgroundThe ongoing COVID-19 pandemic is characterized by different morbidity and mortality rates across different states, cities, rural areas, and diverse neighborhoods. The absence of a national strategy for battling the pandemic also leaves state and local governments responsible for creating their own response strategies and policies.ObjectiveThis study examines the content of COVID-19–related tweets posted by public health agencies in Texas and how content characteristics can predict the level of public engagement.MethodsAll COVID-19–related tweets (N=7269) posted by Texas public agencies during the first 6 months of 2020 were classified in terms of each tweet’s functions (whether the tweet provides information, promotes action, or builds community), the preventative measures mentioned, and the health beliefs discussed, by using natural language processing. Hierarchical linear regressions were conducted to explore how tweet content predicted public engagement.ResultsThe information function was the most prominent function, followed by the action or community functions. Beliefs regarding susceptibility, severity, and benefits were the most frequently covered health beliefs. Tweets that served the information or action functions were more likely to be retweeted, while tweets that served the action and community functions were more likely to be liked. Tweets that provided susceptibility information resulted in the most public engagement in terms of the number of retweets and likes.ConclusionsPublic health agencies should continue to use Twitter to disseminate information, promote action, and build communities. They need to improve their strategies for designing social media messages about the benefits of disease prevention behaviors and audiences’ self-efficacy.     

The psychological burden of waiting for procedures and patient‐centred strategies that could support the mental health of wait‐listed patients and caregivers during the COVID‐19 pandemic: A scoping review

BackgroundWaiting for procedures delayed by COVID‐19 may cause anxiety and related adverse consequences.ObjectiveTo synthesize research on the mental health impact of waiting and patient‐centred mitigation strategies that could be applied in the COVID‐19 context.MethodsUsing a scoping review approach, we searched 9 databases for studies on waiting lists and mental health and reported study characteristics, impacts and intervention attributes and outcomes.ResultsWe included 51 studies that focussed on organ transplant (60.8%), surgery (21.6%) or cancer management (13.7%). Most patients and caregivers reported anxiety, depression and poor quality of life, which deteriorated with increasing wait time. The impact of waiting on mental health was greater among women and new immigrants, and those of younger age, lower socio‐economic status, or with less‐positive coping ability. Six studies evaluated educational strategies to develop coping skills: 2 reduced depression (2 did not), 1 reduced anxiety (2 did not) and 2 improved quality of life (2 did not). In contrast, patients desired acknowledgement of concerns, peer support, and periodic communication about wait‐list position, prioritization criteria and anticipated procedure date.ConclusionsFindings revealed patient‐centred strategies to alleviate the mental health impact of waiting for procedures. Ongoing research should explore how to optimize the impact of those strategies for diverse patients and caregivers, particularly in the COVID‐19 context.Patient or Public ContributionSix patients and four caregivers waiting for COVID‐19‐delayed procedures helped to establish eligibility criteria, plan data extraction and review a draft and final report.     

“If You Don't Ask,I'm Not Going to Tell You”: Using Community-Based Participatory Research to Inform Pregnancy Intention Screening Processes for Black and Latina Women in Primary Care

BackgroundPublic health and medical professional organizations recommend screening women of reproductive age for pregnancy intention (PI) routinely in primary care. Existing PI screening tools may not address the complexity of intentions for women of color or lower socioeconomic status or be well-suited to primary care settings. This study sought to inform recommendations for carrying out PI screening meaningfully in primary care settings.MethodsThis community-based participatory research project united staff from a research institution, community health organization, and federally qualified health center in a predominantly Latina community in New York City. The Community Advisory Board members designed the research question, developed qualitative interview guides, and conducted in-depth interviews with 30 English- and Spanish-speaking female federally qualified health center patients ages 15 to 49. Community Advisory Board members developed an initial codebook using an inductive approach and refined themes throughout the coding process. After coding, Community Advisory Board members created a conceptual map representing relationships between key themes, and generated data-informed recommendations for PI screening practices that are relevant and feasible in the community context.ResultsParticipants expressed a range of experiences with PI screening processes, depending on medical histories, attitudes, norms, and perceived benefits of screening. Three central themes emerged through frequency of occurrence, consistency in content, and relevance as reflected in concept mapping: agency, judgment and shame, and expertise versus authority. Recommendations included specific strategies and wording providers could use to explain the rationale and context for discussing PI.ConclusionsFuture work should examine the experience and effectiveness of implementing these community-based participatory research–derived recommendations in primary care.     

社区防制SARS的实证分析--突发公共卫生事件防制策略研究之三

社区有一支职业化的社区工作队伍，有固定的机关、医院等机构，能开展和协调社区工作；社区内人群相对稳定，便于管理。社区是整个社会预防和抵御SARS的重要组成部分。社区要调动一切力量，严格监控，积极开展如爱国卫生运动、健康教育等工作，防制SARS的发生和扩散。     

Views of men with Parkinson's disease regarding physical activity health messaging

BackgroundMany men with Parkinson's Disease (PD) do not meet the recommended levels of physical activity (PA) for health benefits. Tailored, meaningful, and culturally sensitive PA health messages may be a catalyst to shape men's motivations toward participation.ObjectiveWe explored the views of New Zealand (NZ) men with PD about existing PA health messages, and how these could be adapted to be more effective.MethodsThis qualitative study recruited six community dwelling, regularly physically active, NZ European men with PD (aged 54–69 years, 2–18 years post-diagnosis) from a community exercise class in Canterbury, NZ. Participants engaged in semi-structured interviews which were audio-recorded, transcribed verbatim, and analyzed inductively for themes.ResultsParticipants expressed that effective PA health messages should reflect men's motivations for PA which included physical and mental well-being and social connection. Inclusive, positive, and relatable language and imagery were considered crucial PA message communication strategies. Participants viewed health professionals' PA advice as superficial and unhelpful; however, celebrities with PD were considered inspirational messengers. Messages endorsed by trustworthy sources, such as the Parkinson's Society, were perceived to enhance the credibility.ConclusionsEffective PA messages should be gain framed and tailored to the target audience. We recommend health professionals provide comprehensive PA advice or consider onward referral. Future research which uses a co-design participatory methodology to collaborate with men with PD from culturally diverse backgrounds and represent all stages of PA behaviour change is recommended to provide comprehensive insights for meaningful, effective, and culturally sensitive PA health messaging.     

“Do It Now!” Yakima, Wash, and the Campaign Against Rural Typhoid

In 1911, Yakima, in western Washington, suffered a typhoid epidemic that turned the nation's attention to a crisis in public health. The response exemplified the ideals of the "new public health" as a more proactive, scientific, federal commitment to the problems of rural America. A US Public Health Service investigation led by Dr Leslie Lumsden found a typhoid mortality rate of nearly 5 times the national average. The cause was bad sanitation. Typhoid rates dropped dramatically as the community adopted pragmatic solutions. Lumsden helped organize a "Do It Now" sanitation campaign and one of the country's first city-county health units. Yakima provided a model for other rural areas and small towns across the country. This episode in one of the country's most productive fruit-growing regions raised serious questions regarding the geographic dynamics of disease. For Lumsden and other like-minded health officials, the countryside represented a dangerous reservoir of disease, a particular threat to the nation's agriculturally dependent urban populations. Yakima showed that the country needed a more comprehensive public health system that addressed urban and rural problems.     

对公共场所卫生监督存在问题探讨

  目的  了解辽阳市公共场所卫生基本现状,掌握重点公共场所主要微生物健康危害因素,评价健康风险,为加强公共场所卫生管理和防控疾病提供依据。  方法  依据《公共场所卫生管理条例》、《全国公共场所健康危害因素监测》项目技术方案,开展公共场所健康危害因素监测试点,对宾馆（酒店）、游泳场（馆）、沐浴场所、理发（美容）店、候车室等5类重点公共场所的室内空气、水（冷却塔冷却水、淋浴水、游泳池水）、公共用品用具与公共设施设备、从业人员微生物样品按季度开展健康危害因素监测。检测项目共6类,分别为菌落总数、真菌总数、大肠菌群、耐热大肠菌群、金黄色葡萄球菌、嗜肺军团菌。  结果  2016 — 2019年共对52家宾馆、游泳场所、沐浴场所、理发（美容）店、候车室等5类重点公共场所进行卫生检测,共检测微生物样品8 757份。结果显示,公共场所室内空气合格率为100 %;公用用品用具细菌总数合格率为95.3 %,大肠菌群除毛巾、候车室座椅扶手其余均未检出,金黄色葡萄球菌均未检出。游泳场所大肠菌群合格率为99 %;沐浴场所嗜肺军团菌检测合格率为100 %。合格率偏低的项目主要为细菌总数（理发剪刀、理发梳）。  结论  沐浴场所、理发店卫生状况较差,应加大监督抽检力度,加强从业人员卫生安全知识的健康教育,增加消毒措施,改善公共场所卫生状况。     

The prospective role of personal health records in streamlining and accelerating the disability determination process

BackgroundThe disability community could benefit significantly from the widespread adoption of health information technology, in particular from its ability to streamline and accelerate processing of the estimated 3 million disability benefits applications filed with the Social Security Administration each year. Disability determination is an inefficient, largely paper-based process requiring large volumes of clinical data compiled from multiple provider sources. That, coupled with a lack of transparency within the process, adds unnecessary delays and expense.ObjectiveThe objective of this paper is to outline the case for how personal health records, particularly those populated with information from provider-held electronic health records and payer claims data, offer a means to achieve financial savings from shortened disability determination processes, as well as a tool for disability health self-management and care coordination.MethodsDrawing from research and policy forums and testimony before the American Health Information Community, the importance of including the disability community as the nation moves forward with health information technology initiatives is explored.ResultsOur research suggests that systemwide improvements such as the Nationwide Health Information Network and other such health information technology initiatives could be used to bring benefits to the disability community.ConclusionsThe time has come to use health information technology initiatives so that federal policy makers can takes steps to reduce the inefficiencies in the Social Security Administration disability determination process while improving the program's value to those who need it the most.