Trusted messengers and trusted messages: The role for community-based organizations in promoting COVID-19 and routine immunizations

We sought to explore the trust and influence community-based organizations have within the communities they serve to inform public health strategies in tailoring vaccine and other health messages.A qualitative study was conducted between March 15 – April 12, 2021 of key informants in community-based organizations serving communities in and around Philadelphia, Pennsylvania. These organizations serve communities with high Social Vulnerability Index scores. We explored four key questions including: (1) What was and continues to be the impact of COVID-19 on communities; (2) How have trust and influence been cultivated in the community; (3) Who are trusted sources of information and health messengers; and (4) What are the community’s perceptions about vaccines, vaccinations, and intent to vaccinate in the context of the COVID-19 pandemic.Fifteen key informants from nine community-based organizations who serve vulnerable populations (e.g., mental health, homeless, substance use, medically complex, food insecurity) were interviewed. Five key findings include: (1) The pandemic has exacerbated disparities in existing social determinants of health for individuals and families and have created new concerns for these communities; (2) components of how to build the trust and influence (e.g., demonstrate empathy, create a safe space, deliver on results)resonated with key informants; (3) regardless of the source, presenting health information in a respectful and understandable manner is key to effective delivery; (4) trust and influence can be transferred by association to a secondary messenger connected to or introduced by the primary trusted source; and (5) increased awareness about vaccines and vaccinations offers opportunities to think differently, changing previously held beliefs or attitudes, as many individuals are now more cognizant of risks associated with vaccine-preventable diseases and the importance of vaccines.Community-based organizations offer unique opportunities to address population-level health disparities as trusted vaccine messengers to deliver public health messages.     

Code poverty: An adaptation of the social-ecological model to inform a more strategic direction toward nursing advocacy

The purpose of this discussion paper is to explore how nurses can be strategically poised to advocate for needed policy change in support of greater income equality and other social determinants of health. We adapted Bronfenbrenner's social-ecological model to highlight how four broad pervasive subsystems shape the opportunities that nurses have to engage in advocacy at the policy level. These subsystems include organizations (the microsystem), professional bodies (the mesosystem), public policies (the exosystem), and societal values (the macrosystem). On the basis of this adapted model, we recommend changes among modifiable elements of the microsystem and mesosystem that can help position nurses (ecologically and collectively) to advocate for public policy change and use examples from a Canadian context to illustrate these points. We believe that the ideas arising from this model can be widely used where policy action on the social determinants of health is needed to inform, guide, and frame change efforts and advocacy work.     

Unexpected capacity-building experiences of multicultural,multilingual participants in a public health initiative

Aims

This study of a levy-voter funded public health initiative program (1) identifies capacity-building concerns, (2) summarizes those concerns at the community-based organization (CBO) level, and (3) documents the desired CBO capacity-building outcome.

Participants

Nineteen participants from nine CBOs were included, representing 95% of participants (19/20) and 90% of CBOs (9/10) from the initiative's program population.

Methods

Interviews were conducted. A focus group validated data. Demographic surveys were completed.

Methodology and Analysis

Data were analyzed using demographic and inductive content analyses. Fifteen capacity-building unexpected concerns were identified. Participants from eight out of nine (88.8%) CBOs shared at least ten concerns. Seven CBO capacity-building outcomes were identified.

Results

Capacity-building providers helped participants mitigate the Initiative's capacity-building testing of the National Implementation Research Network (NIRN) model. Participants' NIRN processes were Western and mainstream. Participants wanted community-designed processes and the funder to understand CBO clients’ backgrounds, cultures, and languages. The contract money did not match the needed capacity-building processes, time, and workload.

Discussion

The funder's pre-selected the NIRN Western majority approach did not fit. Participants wanted to lead. Capacity-building only for home-based program development was less desired. Social justice leadership could have made a difference.     

Current landscape of kidney allocation: Organ procurement organization perspectives

Organ procurement organizations (OPOs) play a central role in the recovery, preservation, and distribution of deceased donor kidneys for transplantation in the United States. We conducted a national survey to gather information on OPO practices and perceived barriers to efficient organ placement in the face of the new circle-based allocation and asked for suggestions to overcome them. Of the 57 OPOs, 44 responded (77%). The majority of OPOs (61%) reported barriers to obtaining a kidney biopsy, including lack of an available pathologist. Most OPOs (55%) indicated barriers to pumping owing to a lack of available staff and transportation. Respondents agreed or strongly agreed that the new allocation system has worsened transportation challenges (85%), increased provisional acceptances of kidneys (66%), increased communication challenges with transplant centers (68%), and worsened the efficiency of organ allocation (83%). OPO-suggested solutions include making transplant centers more accountable for inefficient selection practices, developing reliable transportation options, and removing the requirement for national sharing. These findings underscore the need to examine closely the trade-offs of the new allocation system with respect to costs, organ ischemia, and discard. These findings may help inform practice and policy for overcoming transportation barriers and improving the efficiency of organ placement.     

获得社区组织关怀的新发现男性HIV感染者特征分析

目的：了解社区组织参与关怀的新发现男性HIV感染者特征。方法：收集2010年11月-2011年7月在天津和武汉疾控中心确认并转介到当地项目合作的感染者组织的新发现感染者，进行基本资料登记，了解与感染相关信息并进行统计分析。结果：94例新发现感染者接受了阳性转介服务。56．4％为当地人；平均年龄33．7岁；50％未婚；56．4％独居，35．1％与异性同居；高中及以下学历占59．5％；待业人员26．6％，服务行业人员25．5％；35．1％没有收入，而月收入不足2000元者为21．3％；88．5％因男男性行为感染；平均自报安全套使用率仅为30．7％。总体和对男男性行为者分析发现文化程度高安全套使用率也相对增高；已婚和低文化程度使感染途径呈现多样性。结论：流动人口与当地居民都是重要的干预对象。高学历群体中的男男性行为问题要引起足够重视，同样也不能放弃低收入、低学历人群的知识普及和安全套促进。     

Factors affecting the advancement of Black nurses into leadership roles: A scoping review

BackgroundThe profession of nursing has recognized the lack of diversity in nursing leadership. Nurses of color represent fewer than 20% of leadership roles in nursing administration, education, and professional organizations. Efforts are needed to identify and implement strategies to increase the representation of nurses of color in positions of high influence.PurposeTo review the literature to uncover the factors that may impact Black nurses in their pursuit of leadership roles in nursing administration, education, and professional organizations.MethodsThe authors conducted a scoping review, searching CINAHL and PubMed databases in November 2022 for peer-reviewed English-language studies of leadership among U.S. nurses. They excluded studies that did not include a research method, did not have participants, a minimum of baccalaureate preparation as an inclusion criterion for participants, or were published before January 1, 2012.DiscussionOf 331 articles identified, a total of 12 met the inclusion criteria. Evaluation of the studies revealed three concepts related to mentorship, racism, and hiring practices. Of the 12 studies, 9 addressed issues related to mentorship, 5 addressed issues related to racism, and 2 addressed issues related to hiring practices. Some studies address more than one of the concepts. Ten were qualitative studies, and two were quantitative studies.ConclusionFindings suggest that Black nurse leaders are faced with obstacles and challenges when considering entering and/or staying in leadership roles. The limited amount of research on Black nurses in leadership roles remains inadequate.