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Objective: The impact of social media on public health has been examined in various studies. However, none have explored user engagement based on the type of Facebook posts related to renal disease. Therefore, the present study sought to determine which type of nephrology-related posts have greater user engagement. Setting(s): Facebook pages. Method(s): The posts on a specific Facebook page curated by a team of nephrologists in Malaysia were examined in this cross-sectional study. The type of post, likes, comments, shares of a post and reach of a post were used for data analysis. Analysis of variance was used to quantify the relative contribution of each independent variable to the odds of the post being highly liked or shared. The Kruskal-Wallis test was used to compare links, photos, shared videos, status and videos for parameters such as reach, the number of times a specific piece of content has been displayed on a screen (impressions), and user engagement. Result(s): Shared videos and photos received the highest median reach of 5,862 and 5,880, respectively. People who 'liked' the page in 2019, 2020 and 2021 numbered 193, 4,196 and 2,835, respectively. Among the types of content on the Facebook page, photos and shared videos received the highest median lifetime reach of the post compared to links, status and videos in terms of 'people who liked the page'. Conclusion(s): The study findings suggest that posting a video or photo maximises the chance of engagement and meaningfully impacts public health outcomes.Copyright © The Author(s) 2023.
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Background: Integrative therapies are shown to support cancer patients' treatment plans, help with side effect management, and improve patients' quality of life ([1-9]). In 2017, the American Society of Clinical Oncology endorsed the Association of Integrative Oncology's Clinical Practice Guidelines highlighting their importance in breast cancer care. Recent studies suggest that more evidence is needed to bring attention to the role of integrative therapies in advanced breast cancer care [4, 7, 8, 10]. This analysis explores participants' experiences with a wellness program implemented by Unite for HER (UFH), a non-profit organization that delivers integrative therapies and support services such as whole food nutrition services, medical acupuncture, oncology massage therapy, counseling, reiki, meditation, yoga, and fitness classes to patients with breast, metastatic breast, and ovarian cancer. As of April 2022, there were over 1,700 women diagnosed with metastatic breast cancer (MBC) participating in UFH locally and nationally. Method(s): UFH members completed a survey about the impact of the UFH Wellness Program on the overall quality of life, including measures on side-effect management, OTC/prescription drug utilization rate, stress reduction, changes to wellness habits, and the social and emotional challenges associated with living with MBC. In total, 119 unique UFH members with MBC answered online surveys distributed by email in 2020 and 2021. Survey questions were designed to evaluate the impact of the UFH Wellness Program. Descriptive analyses of survey questions and openended comments were conducted to assess program impact. Result(s): All respondents were MBC patients/survivors. No other demographic information was collected. While 2020 respondents received mostly in-person services for part of their program, all 2021 respondents received primarily virtual services due to the Covid-19 restrictions. Despite the inaccessibility of in-person services, the satisfaction levels with the wellness program did not drop significantly in 2021. More than two-thirds of respondents (80% in 2020, 67% in 2021) indicated that the therapies offered through UFH Wellness Program significantly improved the side effects of their treatment for MBC. Notably, more than a quarter of respondents (28% in 2020, 26% in 2021) specified that due to UFH integrative therapies they were able to reduce or eliminate one or more OTC/prescription drugs to manage side effects. At the same time, the majority reported experiencing reduced levels of stress after utilizing integrative therapies offered by UFH (93% in 2020, 81% in 2021), as well as improvements in their emotional wellbeing (95% in 2020, 83% in 2021), and quality of life during or after treatment for MBC (97% in 2020, 96% in 2021). Also, 86% of respondents in both years indicated that UFH services, such as nutrition counseling, cooking classes, and exercise classes, helped them adopt and maintain healthier habits in their life. Furthermore, a qualitative analysis of open-ended comments found that 1) respondents expressed deep gratitude and appreciation for UFH integrative therapies, 2) noted that they would otherwise not be able to access such therapies due to financial barriers, and 3) helped them feel better prepared to cope with the psychosocial aspects of their MBC experience. Discussion(s): These results suggest that integrative therapies such as those offered by UFH can play a significant role in improving patients' outcomes by reducing stress and drug utilization to manage side effects and improving patients' well-being and quality of life during metastatic breast cancer treatment. These findings highlight the importance of choosing integrative oncology programs to support MBC patients' needs in managing the psychosocial and physical side effects of the disease.
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Background: There is considerable evidence suggesting that parenting programmes reduce violence against children (VAC). Based on this evidence, there have been calls for implementation of parenting programmes at scale. However, most of the existing evidence on implementation quality and scale-up comes from high-income countries and very little research ascertains the perspectives and experiences of programme implementers from low-income settings. Objective(s): To explore the views and experiences of implementers from six non-profit organisations who delivered Parenting for Lifelong Health for Teens (PLH-Teens) programme at scale in Tanzania in 2020 and 2021. Method(s): This paper employed a qualitative research design involving 44 in-depth interviews and 12 focus group discussions (FGDs) with facilitators, coaches, and local implementing partners (LIPs). Data were collected on implementers' experiences of delivering the programme at scale by exploring topics including programme delivery, training and support they received and details around programme logistics. All interviews and FGDs were audio-recorded with the permission of the participants. With the aid of NVIVO 12 qualitative analysis software, thematic analysis was used to synthesise the interview and FGD data. Result(s): Thematic analyses of the interviews and FGDs revealed three themes: 1) implementers' reflections on factors promoting scale-up;2) implementers motivation for implementation of the programme;and 3) barriers to scale up. Implementers described factors that promoted successful scale up as: planning and working closely with community organisations, which enhanced trust and buy-in;delivering the programme through role plays;and delivery by skilled implementers. Implementers were motivated to deliver the programme at scale for reasons such as prestige/respect, financial incentives, and acquiring skills for their own parenting. This study highlights barriers to programme scale-up as: conflicting demands on staff time;beneficiaries' initial doubt of the programme's value;COVID-19 related disruptions;and logistical challenges that affected how both implementers and parents/caregivers engaged with the programme. Despite these obstacles, implementers remained flexible in scheduling and adapting the programme to ensure successful completion. Conclusion(s): This paper highlights the perspectives of staff implementing a parenting programme aiming to reduce VAC at scale. The study suggests that several factors support staff in delivering the programme whereas other factors hindered successful implementation. It is important for all programme stakeholders to understand these factors and find ways of addressing them for desired programme impact. The study also reveals that the successful delivery of parenting programme should allow for flexibility in modes of delivery by allowing for necessary adaptations and adjustments.
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Background: Although the COVID-19 pandemic quickly created a spotlight on distance learning, identifying models that can deliver effective educational programs and best serve the needs of oncology clinicians remains a significant challenge. Methods: We conducted an educational program on the evolving standards of care for advanced HER2+ breast cancer hosted on a novel digital platform that offers a personalized social learning experience which prioritizes engagement, peer-to-peer learning, and mentorship within a small group setting. Results: 87 learners within 10 groups of professionallyconnected clinicians participated. Learners progressed through foundational self-study modules, collaborated on asynchronous group challenges, and participated in synchronous live group discussions over six weeks (approximately 4 hours total). Quantitative and qualitative analysis of data extracted from these components highlights the impact of this program (Table). Notably, the learner population was more specialized and engaged than could be expected of a traditional CME program. Feedback suggests strong impact of the live group discussions on learners' intended practice changes. Additionally, analysis of group challenges and live group discussions revealed several key insights into learner thinking about treatment guidelines, including their differing opinions about the role of surgery/radiation in patient care, uncertainty about the mechanisms of action (MOAs) of discussed therapies, and their apprehension about implementing therapies that may impact the heart and lungs. Conclusions: The outcomes from this analysis highlight the utility of this type of social learning platform to create a safe, supportive learning environment that encourages multiple real-time and asynchronous interactions and shared experiences between clinicians who treat patients with advanced HER2+ breast cancer, as well as offering unique and convenient mentoring opportunities for clinicians interested in leading these digital small groups. Program impact.
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STATEMENT OF PROBLEM/QUESTION: The Covid-19 pandemic disproportionally affected low-income and Black and Latinx New Yorkers, led to disengagement from primary care, increased social needs, and worsened chronic diseases. DESCRIPTION OF PROGRAM/INTERVENTION: Community Health Workers (CHWs) are front line public health workers who are trusted members of and/or have a close understanding of the community served. Integrating CHWs into clinical teams can help to bridge gaps between the healthcare system and a patient's community. In 2021, NYC Health + Hospitals (NYC H+H) established a branch of the NYC Public Health Corps, comprised of over 200 CHWs and program staff in multiple care settings to address the health inequities exacerbated by the pandemic. CHWs are embedded in and hired by clinics while a centralized team coordinates training, program models, data/documentation tools and coaching by a team of CHW coaches. CHWs in adult primary care implement a model informed by the UPenn IMPaCT program in which CHWs provide tailored social support, advocacy and navigation to help patients achieve health goals. (Kangovi et al 2014, 2017, 2018). CHWs work intensively with patients who have 2+ chronic conditions over 3 months on a set of patient-driven goals. Goals fall into four categories: social needs, medical system navigation, medication management, and chronic disease risk factors. CHWs are provided guides and training on how to address specific patient goals. MEASURES OF SUCCESS: Initial measures include: 1. Launch success (# CHWs hired, development of documentation workflows). 2. Implementation of program model (# patients enrolled, goals identified). Long-term measures of success will include a cost effectiveness analysis. FINDINGS TO DATE: Between August and December 2021, approximately 200 CHWs were hired to staff 17 different clinical sites. 147 CHWs were hired for adult primary care and 58 have begun working with patients. All CHWs have completed IMPaCT and supplemental training. All CHWs document in the EMR using a specific build. 924 patients have been outreached, 365 enrolled, and 54 completed the program to-date. CHW median caseload is 7 with a goal to ramp up to 20. CHWs address an average of 5 goals per patient. The most common goals are primary care engagement, medication management, health insurance gaps/medical bills, and food insecurity. 60% of patients identified at least one social need to work on with the CHWs. KEY LESSONS FOR DISSEMINATION: 1. H+H was able to quickly build one of the largest CHW workforces in the country in response to patient needs elevated by the pandemic and availability of public funding by embedding CHW teams in clinics with central program support, increasing the likelihood of sustainability over time. 2. The development of a structured CHW program supported by training, coaching and documentation tools to address the most common issues affecting patient ability to manage health and wellbeing including social needs was critical in supporting this new workforce while allowing for flexibility to meet individual patient needs.
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STATEMENT OF PROBLEM/QUESTION: Ohio Appalachia faces women's health disparities in chronic disease burden, maternal morbidity and mortality, and health care access, including preventive services. DESCRIPTION OF PROGRAM/INTERVENTION: Ohio Better Starts for All (BSFA), funded by the March of Dimes, provides in-person and telehealth care for women of childbearing potential within a 4 county region in Ohio Appalachia. After 18 months of regional engagement and a clinical partnership between Adena Health (community) and the Ohio State University (tertiary), Ohio BSFA began pilot in-person clinical and community education programs, prioritizing locations >20 minutes from established clinical sites. FirstNet, a first responder broadband network, helped us establish a mobile unit hotspot for patients to access subspecialty telehealth care starting in Spring 2022. Yet, regional infrastructure, workforce, financial resource, maintenance, and COVID-19 challenges limited scope and reach of clinical services. MEASURES OF SUCCESS: Ohio BSFA applied the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to guide program development, refinement, and expansion. To evaluate progress, we measured: number of clinics conducted;number of patients served;percentage of Ohio BSFA referrals served;demographics of patients served;and number of community partners. We next anticipate assessing quality of care (e.g. preventive services, depression screening, and tobacco cessation), number of telehealth visits, and patient satisfaction. FINDINGS TO DATE: Since the Fall 2021 launch, we conducted 14/19 scheduled clinics serving 52/86 (60.5%) of referred patients. We canceled 5 clinics due to inclement weather, mobile unit breakdown, or clinician COVID-19 infection. Data are available for 36 of 52 patients served to date (due to a monthly demographic reporting lag). Median age was 27 years;25% (9/36) were teenagers;92% (33/36) were White. 61% (22/36) had public insurance;31% (11/36) had private insurance;and 8% (3/36) were uninsured. We established 5 community partnerships, such as a county fairgrounds and a local employer, General Mills, to support mobile unit housing and clinic hosting. KEY LESSONS FOR DISSEMINATION: We have learned that a mobile hybrid in person/ telehealth clinical model can promote primary and specialty care access in rural communities. Using the RE-AIM framework in program implementation helps maintain focus on long-term community sustainability, even in early stages of program development. Continuous community partnership and coalition expansion is also critical for sustainability. While telehealth can facilitate rural subspecialty care access, telehealth success requires broadband access and established referral workflows. Clinical service disruption, such as staffing shortages and facility malfunction, can hinder patient engagement and program momentum. Agile and flexible responses to unanticipated challenges, compounded by the COVID-19 pandemic, facilitate continuation of clinical and community services necessary for increasing program impact and reach.