Integra Project: strengthening social participation in the agenda of health policies, services, and technologies. / Projeto Integra: fortalecimento da participação social na agenda das políticas, serviços e tecnologias em saúde.

The 16th National Health Conference illustrated the interest of health councils to intervene in public policies in order to guarantee the right to health technologies. The INTEGRA project (Integration of policies for Health Surveillance, Pharmaceutical Care, Science, Technology, and Innovation in Health) is a partnership among the National Health Council, the National School of Pharmacists, and the Oswaldo Cruz Foundation (Fiocruz), with support from the Pan American Health Organization (PAHO), with the goal of strengthening participation and social engagement in the theme, as well as the integration of health policies and practices within different sectors of society (social movements, health councils, and health professionals), with the various stages related to the access to medicines (research, incorporation, national production, and services) being the main theme in the context of the COVID-19 pandemic. It seeks to offer training for leadership groups in the health regions and activities with a broad national and political scope, and it hopes to establish an intersectorial and integrated network of leaders capable of acting collaboratively to defend the development of science, public policies, national sovereignty, and social control of health.

A 16ª Conferência Nacional de Saúde demonstrou o interesse do controle social em intervir sobre as políticas públicas a fim de garantir o direito às tecnologias de saúde. O projeto Integra - Integração das Políticas de Vigilância em Saúde, Assistência Farmacêutica, Ciência, Tecnologia e Inovação em Saúde -, nasce da parceria entre o Conselho Nacional de Saúde, a Escola Nacional dos Farmacêuticos e a Fundação Oswaldo Cruz (Fiocruz), com apoio da Organização Pan-Americana de Saúde (OPAS) com objetivo de fortalecimento da participação e engajamento social na temática e a integração das políticas e práticas de saúde em diferentes setores da sociedade (movimentos sociais, controle social e profissionais de saúde), tendo as diversas etapas relacionadas ao acesso aos medicamentos (pesquisa, incorporação, produção nacional e serviços) como mote principal, no cenário da pandemia de COVID-19. Oferta-se, neste projeto, capacitação para grupos de lideranças nas regiões de saúde e atividades de grande abrangência nacional e política. Espera-se alcançar o estabelecimento de uma rede intersetorial, integrada de lideranças capazes de atuar colaborativamente para a defesa do desenvolvimento da ciência, das políticas públicas, da soberania nacional e do controle social da saúde.

Effects of the COVID-19 Pandemic on Access to Education and Social Participation in Children and Adolescents with Duchenne Muscular Dystrophy in Switzerland.

Two-thirds of patients with Duchenne muscular dystrophy (DMD) have cognitive and neuropsychiatric problems. Concerning their quality of life, negative factors are the lack of qualifying education and social participation in sporting and leisure activities. Adapted assistance in education and participation in social life are thus important. During the coronavirus disease 2019 (COVID-19) pandemic, the pediatric population was less severely impacted by the disease, but by the restrictions associated. The aim of this study was to evaluate the impact of the COVID-19 pandemic regarding access to education and social participation for young patients with DMD in Switzerland. We conducted a survey study from May to August 2021 assessing the impact of the COVID-19 pandemic on access to education and social participation in 8 to 18 years old patients with DMD in Switzerland. Of 60 sent surveys, 40 were returned and included. Mean age of participants was 13.5 years (±3.1 standard deviation); 23/40 of the participants were wheelchair bound, 21/40 attended a special school, and 19/40 a regular school. Of the 22/40 participants receiving assistance at school, 7/40 reported a change caused by the pandemic: for 5/7, the assistance was paused. Of the 12 boys and adolescents attending sporting activities, 10 had to suspend these. Nine attended other leisure activities; for 3/9, these activities were paused. The COVID-19 pandemic had direct effects on school assistance, sporting, and leisure activities in young patients with DMD in Switzerland. It is important to ensure that school assistance and leisure activities are rapidly resumed.

Improving Participation among Youth with Disabilities within Their Unique Socio-Cultural Context during COVID-19 Pandemic: Initial Evaluation.

BACKGROUND: Participation in meaningful activities is important for quality of life among youth with disabilities; yet participation is often restricted during adverse times. This study aimed to explore the effectiveness of the Pathways and Resources for Engagement and Participation (PREP) intervention among ultra-Orthodox Jewish Israeli youth with disabilities during the COVID-19 pandemic. METHODS: A 20-week single-subject research design with multiple baselines measuring participation goals/activities was employed with two youths (15 and 19 years old) combining quantitative and qualitative descriptive data. Changes in participation levels were measured biweekly using the Canadian Occupational Performance Measure; COPM; participation patterns were measured using the Participation and Environment Measure-Children and Youth; PEM-CY pre- and post-intervention; parents' satisfaction was measured using the Client Satisfaction Questionnaire, CSQ-8. Semi-structured interviews were conducted post-intervention. RESULTS: Both participants significantly improved participation in all selected goals and participation patterns, and were highly satisfied with the intervention. The interviews revealed additional information on personal and environmental barriers, factors supporting intervention, and intervention effects. CONCLUSIONS: The results indicated that an environment-centered and family-centered approach can potentially improve the participation of youths with disabilities within their unique socio-cultural context, during adverse times. Flexibility, creativity, and collaboration with others also contributed to intervention success.

Factors Associated with Chinese Migrant Children's Social Engagement during the COVID-19 Pandemic: A Case Study in Guangzhou City, China.

This study aims to examine whether social work services can improve migrant children's social engagement during the COVID-19 pandemic in urban China. Valid questionnaires of 416 migrant children in Guangzhou were obtained as the samples. Two regression models were employed to analyze the factors associated with social engagement. The results show that during the pandemic, migrant children with higher self-efficacy, higher community social capital, and better social inclusion tended to have higher social engagement. Among the three dimensions of social capital, only community social capital has a significant positive effect on migrant children's social engagement. The degree of social inclusion of migrant children affects their social engagement. Social work services are beneficial to promoting the social engagement of migrant children. The research has implications for the practice of child social workers. First, it is important to cultivate migrant children's self-efficacy to promote social engagement. Second, social workers should build the social capital of the communities where migrant children live to promote the social engagement of this group. Third, social workers should strengthen support for migrant children's learning during the COVID-19 pandemic.

Older adults' community participation, physical activity, and social interactions during and following COVID-19 restrictions in Australia: a mixed methods approach.

BACKGROUND: With the increasing age of the global population, key components of healthy ageing including community, physical, and social participation continue to gain traction. However, management of the COVID-19 pandemic aimed to protect older adults and reduce the spread of the virus, this restricted community participation and reduced the opportunities for social interaction. METHODS: This mixed methods study investigates community dwelling older adults' community participation; physical activity and social interaction prior to, during, and following the COVID-19 lockdown in Adelaide, Australia. Twenty-six community dwelling older adults were monitored over three time-points between November 2018 and October 2020, with Global Positioning Systems, accelerometry and self-reported diaries. In addition, nineteen participants completed semi-structured interviews. RESULTS: Community participation varied across the three time points, with significant reduction in the number of trips taken out-of-home (p = 0.021), social interactions (p = 0.001) and sleep quality (p = 0.008) during restrictions. Five themes were identified to explain personal experiences of community participation during restrictions: (1) Reframing of meaning, (2) Redefining to maintain activities, (3) Revision of risk, (4) Reflection and renewal and (5) Future planning. CONCLUSION: During COVID-19 the physical and social activities of community dwelling older adults changed. Services that support older adults to adapt their activities   , considering their capacities and preferences, to facilitate community participation are required.

Bridging Learning in Medicine and Citizenship During the COVID-19 Pandemic: A Telehealth-Based Case Study.

BACKGROUND: COVID-19 presented great challenges for not only those in the field of health care but also those undergoing medical training. The burden on health care services worldwide has limited the educational opportunities available for medical students due to social distancing requirements. OBJECTIVE: In this paper, we describe a strategy that combines telehealth and medical training to mitigate the adverse effects of the COVID-19 pandemic. METHODS: A toll-free telescreening service, Telecoronavirus, began operations in March 2020. This service was operated remotely by supervised medical students and was offered across all 417 municipalities (14.8 million inhabitants) in the Brazilian state of Bahia. Students recorded clinical and sociodemographic data by using a web-based application that was simultaneously accessed by medical volunteers for supervision purposes, as well as by state health authorities who conducted epidemiological surveillance and health management efforts. In parallel, students received up-to-date scientific information about COVID-19 via short educational videos prepared by professors. A continuously updated triage algorithm was conceived to provide consistent service. RESULTS: The program operated for approximately 4 months, engaging 1396 medical students and 133 physicians. In total, 111,965 individuals residing in 343 municipalities used this service. Almost 70,000 individuals were advised to stay at home, and they received guidance to avoid disease transmission, potentially contributing to localized reductions in the spread of COVID-19. Additionally, the program promoted citizenship education for medical students, who were engaged in a real-life opportunity to fight the pandemic within their own communities. The objectives of the education, organization, and assistance domains of the Telecoronavirus program were successfully achieved according to the results of a web-based post-project survey that assessed physicians' and students' perceptions. CONCLUSIONS: In a prolonged pandemic scenario, a combination of remote tools and medical supervision via telehealth services may constitute a useful strategy for maintaining social distancing measures while preserving some practical aspects of medical education. A low-cost tool such as the Telecoronavirus program could be especially valuable in resource-limited health care scenarios, in addition to offering support for epidemiological surveillance actions.

Aging in Place: Connections, Relationships, Social Participation and Social Support in the Face of Crisis Situations.

OBJECTIVES: We seek to identify active coping strategies used by older adults to face the pandemic and to deal with daily stressors, and to clarify which factors had an effect on stress, positive emotions and depression in active and healthy community-dwelling older adults in the first and second year of the pandemic in Costa Rica. METHODS: Participants were living in their own homes in Costa Rica (n = 218, mean age 69.96, 82.1% women). Participants were interviewed by phone and answered an online survey, which included socio-demographic information, mental health variables such as stressors (perceived health and fear of COVID-19, illness, perception of pandemic gravity), loneliness (whether they felt lonely and how often they felt lonely), access to Information and Communication Technologies, socio-emotional coping variables, social participation and physical activity level during the pandemic. RESULTS: Positive socio-emotional indicators related to well-being such as self-efficacy, social support, perceived health and proactive behavior were high. Negative well-being indicators such as perceived stress, emotional COVID-19 fear and loneliness showed low values in the sample studied during both years. We found significant relations across the dependent variables (perceived stress, positive emotions and depression) by studying the psychological well-being coping strategies. CONCLUSIONS: Findings highlight the importance of coping strategies and social participation in the capacity of older adults to mitigate the negative psychological consequences of crisis situations and provide evidence of "aging in place".

Behavioral, cognitive, emotional and social engagement in mathematics learning during COVID-19 pandemic.

A meaningful engagement of learners is critical in the quality teaching and learning of mathematics at school level. Learner engagement has been an ongoing issue in mathematics classrooms in Nepal and elsewhere. In this context, this study aimed to examine the level of engagement (behavioral, social, emotional, and cognitive activities) and their association with learning mathematics through the virtual mode of instruction during the pandemic. The cross-sectional online survey design was employed among 402 secondary-level mathematics teachers in Nepal. Descriptive statistics, correlation, and structural equation modeling were the major statistical techniques used in research. The findings indicate that the level of behavioral, social, emotional, and cognitive engagement of students was found to be high in the online mode of instruction. Additionally, cognitive engagement has significant highest impact on social, behavior, and emotional engagement.

The relationships between social participation before the COVID-19 pandemic and preventive and health-promoting behaviors during the pandemic: the JAGES 2019-2020 longitudinal study.

BACKGROUND: People's preventive behavior is crucial for reducing the infection and transmission of a novel coronavirus, especially in aging societies. Moreover, since behavioral restrictions may lead to high risks of secondary health impacts among older people, health-promoting behaviors, including proper nutrition intake and regular exercise, should also be encouraged. Although various studies have reported the positive association between social participation and health among older people, whether their social participation relates to preventive and health-promoting behaviors during the COVID-19 pandemic was uncertain. This study examined the relationships between social participation before the COVID-19 pandemic and preventive and health-promoting behaviors during the pandemic among older people in Japan. METHODS: We obtained longitudinal data from the Japan Gerontological Evaluation Study (JAGES), which conducted baseline and follow-up surveys from November 2019 to January 2020 (pre-pandemic) and from November 2020 to February 2021 (during the pandemic) in ten municipalities. In total, 10,523 responses were analyzed. Preventive and health-promoting behaviors were measured by nine actions (e.g., wash/disinfect hands, wear masks, do exercise), and the total of these actions was divided into two (highly implemented ≥7 or not highly implemented <7). Social participation was assessed by nine activities (e.g., participating in volunteering, sports clubs, had paid work). Adjusted for covariates, we examined the relationships between each social participation and preventive and health-promoting behavior by the logistic regression analysis or the Poisson regression analysis. RESULTS: Older people who participated in social activities pre-pandemic showed a tendency to implement preventive and health-promoting behaviors during the pandemic. Especially, participations in "sports" and "Kayoi-no-ba" were positively related to "do exercise." Only "had paid work" was negatively related to highly implemented preventive and health-promoting behaviors. CONCLUSIONS: There were the positive relationships between social participation and preventive and health-promoting behavior. This study also indicated that older people who did not participate in social activities or had paid work before the COVID-19 pandemic may have higher risks of infection and secondary health impacts. Taking into account such old people's lifestyles as well as their workplace conditions, promoting appropriate behaviors need to be considered.

Facilitators and barriers to using virtual reality and augmented reality and its impact on social engagement in aged care settings: a scoping review protocol.

INTRODUCTION: Increasingly more studies are being conducted on the use of virtual reality (VR) and augmented reality (AR) in aged care settings. These technologies can decrease experiences of loneliness which is especially important during the COVID-19 pandemic. With the growing interest in using VR/AR in care settings among older adults, a comprehensive review of studies examining the facilitators and barriers of adopting VR/AR in these settings is needed. This scoping review will focus on facilitators and barriers related to VR/AR in care settings among older adults, as well as the impact on social engagement and/or loneliness. METHODS AND ANALYSIS: We will follow the Joanna Briggs Institute scoping review methodology. We will search the following databases: CINHAL, Embase, Medline, PsycINFO, Scopus and Web of Science. Additional articles will be handpicked from reference lists of included articles. Inclusion criteria includes articles that focus on older adults using VR or AR in aged care settings. Our team (which includes patient and family partners, an academic nurse researcher, a clinical lead and trainees) will be involved in the search, review and analysis process. ETHICS AND DISSEMINATION: We will be collecting data from publicly available articles for this scoping review, so ethics approval is not required. By providing a comprehensive overview of the current evidence on the strategies, facilitators, and barriers of using VR/AR in aged care settings, findings will offer insights and recommendations for future research and practice to better implement VR/AR. The results of this scoping review will be shared through conference presentations and an open-access publication in a peer-reviewed journal.

Association between Social Engagements and Stigmatization of COVID-19 Infection among Community Population in Japan.

In the face of unknown risks, including the coronavirus disease 2019 (COVID-19) pandemic, we tend to have stigmatized perceptions. The current study aimed to examine the association of social engagements with the level of stigmatization of COVID-19 infection among the general population. The data of 429 participants of the Utsunomiya COVID-19 seroprevalence neighborhood association (U-CORONA) study, a population-based cohort study conducted in Utsunomiya City, Japan, were analyzed. Their stigmatized perception of people with COVID-19 infection was evaluated via a questionnaire for the situation if they or others in their community were to get infected. The association between social engagements (community social capital, social network diversity, and social network size) and stigmatization were analyzed by a multiple linear regression model with generalized estimating equations. Overall, females reported a higher stigmatized perception of people with COVID-19 than males. Lower education and depressive symptoms were also positively associated with higher stigmatization, while age, household income, and comorbidities were not. People with higher community social capital reported lower stigmatization (B = -0.69, 95% CI = -1.23 to -0.16), while social network diversity and social network size did not show an association with stigmatization. We found an association between community social capital and stigmatization, suggesting that enhancing their community social capital, but not social network diversity and size, has the potential to mitigate the levels of stigmatization.

Perceived mental health impacts of the COVID-19 pandemic: The roles of social support and social engagement for working age adults in the United States.

In this paper we assess if two protective mechanisms for mental health - social support and social engagement - are associated with lower risk of reporting worsening mental health as a result of the pandemic. Using a demographically representative sample of working age adults in the United States (N = 4014) collected in February and March of 2021, we use logistic regression models to predict self-reported worsening mental health as a result of the pandemic using social support - measured as instrumental and emotional support - and social engagement. We use additional stratified models to determine if these relationships are consistent across rural-urban areas. Results indicate that among urban working age adults, emotional support, high levels of instrumental support, and some types of social engagement were associated with significantly lower risk of worsening mental health. However, among rural working age adults, only emotional support and high levels of instrumental support were significantly associated with lower odds of worsening mental health. Findings suggest that while emotional support may be effective for working age adults in lowering risk of worsening mental health from the pandemic, social engagement may not be for rural residents. The results support use of mental health promotion and prevention approaches that bolster emotional support through familial and local social networks, and raises caution about the efficacy of social engagement approaches in rural contexts.

Whether Social Participation Can Affect the Central Government Public Policy Response to the COVID-19 in China.

Objective: The coronavirus disease 2019 (COVID-19) outbreak has threatened the state's governance and public safety. This study investigates whether and how public participation can affect central government policy response to this pandemic in the context of China. Methods: This study constructs the theoretical framework based on theoretical analysis, and Social Network Analysis is used to analyze data on the public participation, New Media, and the central government response in this pandemic. Results: Findings show that the Chinese central government does not always adopt top-down elitist governance strategies in risk management. The central government will also adopt the bottom-up governance strategy triggered by public participation. In this process, New Media acts as a catalyst. Specifically, when faced with a public emergency and needs a policy response from the central government, public participation firstly creates "participation" with the authority of the media, forms public opinion, and then the prompt policy response from the central government. Conclusion: This study confirms that the central government will refer to public participation to decide the policy response. It also shows that the theory of government response applies to both the local government and the central government.

Development and Validation of a Questionnaire to Assess Social Participation of High Risk-Adults in Germany During the COVID-19 Pandemic.

Background: Restrictions to contain the COVID-19 pandemic affect the social participation of people worldwide. Especially those at high risk for a severe disease tend to abstain from social gatherings. While there are a few questionnaires to measure social participation in elderly or chronic patients, a valid survey instrument that includes pandemic-related social participation is needed. Methods: We developed a social participation questionnaire that aims to assess pandemic-related restrictions in social participation. Items were developed using a theory and literature-based approach and then compiled in a discursive process involving experts and lay people. This was followed by the validation of the questionnaire through a cross-sectional survey on 431 individuals. Items with low item-total correlations and low factor loadings using exploratory factor analysis [EFA] were excluded. Using EFA on the remaining items, the factor structure was retrieved and tested with a confirmatory factor analysis [CFA]. Internal consistency was assessed with Chronbachs α. Results: Initially, 27 items were developed which were used for validation. 13 items were excluded due to low item-total correlations and factors loadings. EFA of the remaining 14 items revealed three factors which were identified as domains "active social participation," "wellbeing," and "restrictions". CFA showed an acceptable model fit using the three-dimensional structure. Chronbachs α of 0.81 and McDonalds Ω of 0.87 indicate good internal consistency. Correlation analysis showed an association between the developed questionnaire and previously-established participation and mental health scales. Conclusion: This study suggests that our 14 item questionnaire is of high reliability and validity and can be used to measure social participation during a pandemic.

Gender-Related Differences in Social Participation Among Japanese Elderly Individuals During the COVID-19 Pandemic: A Cross-Sectional Survey.

INTRODUCTION/OBJECTIVES: The health of elderly individuals is known to benefit from maintaining societal involvement and relationships with other people, such as through social participation. We aimed to determine trends in the percentage of Japanese elderly people who engaged in social participation before and during the coronavirus disease 2019 (COVID-19) pandemic in one municipality in Japan, and compared differences in this status by gender. METHODS: We conducted a cross-sectional questionnaire survey. Questionnaires were sent by mail to 3000 people aged 65 to 85 years who were randomly selected by the administrative staff of the city. Participant characteristics (age, gender, working status, residential status) and their economic status, daily physical activity, and social participation status were obtained at 3 time points: (1) before the COVID-19 pandemic in January 2020; (2) immediately prior to the declaration of a state of emergency in April 2020; and (3) in January 2021, 1 year after (1). RESULTS: A total of 1301 people responded to the survey. The mean age was 73.3 (SD 5.5) years, and 690 (53.0%) were women. There were significant gender differences in terms of living alone, employment status, and amount of physical activity. The number of people reporting social participation gradually decreased from 543 respondents (41.7%) at (1) to 319 (24.5%) at (2) and 251 (19.3%) at (3). Women were more likely to demonstrate reduced social participation. CONCLUSIONS: Elderly individuals, particularly women, reported decreased social participation during the pandemic.

The Impact of COVID-19 Vaccination on the Social Participation of Immunocompromised Persons - Results of a Multicenter Observational Study.

Immunocompromised persons are at an increased risk for a severe SARS-CoV-2 infection and their safety behaviors may influence their social participation. Vaccinated persons have a lower incidence of infection and severe disease when infected compared to non-vaccinated persons. Therefore, their behavior may change and their social participation may increase after a complete vaccination. The aim of this study was to explore social participation of immunocompromised persons before and after complete COVID-19 vaccination. Between March and September 2021, 274 immunocompromised participants were recruited. Survey data were collected at baseline and follow-up from 194 participants including the Index for the Assessment of Health Impairments [IMET], Patient Health Questionnaire-4 [PHQ-4], subjective health status and quality of life. At baseline, participants were not yet completely vaccinated. Complete vaccination was achieved prior to the follow-up questionnaire. IMET scores decreased significantly at follow-up, indicating a higher social participation after complete vaccination. PHQ-4, subjective health status and quality of life did not differ between baseline and follow-up. There were no significant differences across sociodemographic factors. Significant PHQ-4 differences were observed regarding the population size of the participants' home community. Social participation of immunocompromised persons in our study increased after COVID-19 vaccination. Therefore, social participation should be explored further, especially with regards to the impact of vaccination on groups with a high health risk.

Physical, social, and dietary behavioral changes during the COVID-19 crisis and their effects on functional capacity in older adults.

BACKGROUND: This two-year follow-up study aimed to identify factors associated with unhealthy behaviors during the COVID-19 pandemic and examine their impact on functional capacity in older adults. METHODS: Altogether, 536 adults aged ≥65 years participated in this study. The frequency of going out, exercise habits, face-to-face and non-face-to-face interactions, social participation, and eating habits were examined as behavioral factors before and after the first declaration of a state of emergency in Japan. Functional capacity was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence. RESULTS: Using latent class analysis considering changes in the six behaviors, the participants were divided into healthy (n = 289) and unhealthy (n = 247) behavior groups. The male sex was associated with 2.36 times higher odds, diabetes with 2.19 times higher odds, depressive mood with 1.83 times higher odds, poor subjective economic status with 2.62 times higher odds, and living alone with 44% lower odds of being unhealthy. The unhealthy behavior group showed significantly decreased functional capacity (B =-1.56 [-1.98, -1.14]) than the healthy behavior group. For each behavior, negative changes in going out (B =-0.99 [-1.60, -0.37]), face-to-face interaction (B =-0.65 [-1.16, -0.13]), and non-face-to-face interactions (B =-0.80 [-1.36, -0.25]) were associated with a decline in functional capacity. CONCLUSION: Our results showed four factors associated with engaging in unhealthy lifestyle behaviors and how behavioral changes affect functional capacity decline during the COVID-19 pandemic, which will help to develop public health approaches.

Social Engagement and Mental Health Symptoms Across Asian American Ethnic Groups During the COVID-19 Pandemic.

Background: To examine social engagement and mental health symptoms during the COVID-19 pandemic across Asian American (AA) ethnic groups. Methods: Data from three waves of the nationally representative COVID-19 Household Impact Survey (4/20/2020-6/8/2020) were used to describe social engagement and mental health symptoms during the pandemic. Associations between mental health and social engagement were assessed via multinomial logistic regression. Results: In this sample of 312 AAs (36.9% Chinese American, 30.9% South Asian American, 20.1% Filipino/Vietnamese American, and 12.0% Japanese/Korean American), daily communication with neighbors declined for Chinese, South Asian and Filipino/Vietnamese Americans but increased for Japanese/Korean Americans (P=.012) whereas communication with friends/family increased only for Filipino/Vietnamese, Japanese/Korean and South Asian Americans (P<0.001). Differences in self-reported symptoms of anxiety, depression, loneliness, and hopelessness were observed across AA ethnic groups. In adjusted models, lower social engagement was associated with frequent (3-4 days/week) depressive symptoms during the preceding week (cOR:3.26, 95%CI:1.01-10.5). This association was heightened for Asian men (cOR:14.22, 95%CI:3.62-55.8). Conclusions: Heterogeneity of social engagement and mental health symptoms across AA ethnicities was observed. Understanding associations between social engagement and mental health within different communities is necessary to provide culturally and linguistically appropriate mental health treatment and care.