ABSTRACT
Background: This paper describes a UK-based study, SPICES-Sussex, which aimed to co-produce and implement a community-based cardiovascular disease (CVD) risk assessment and reduction intervention to support under-served populations at moderate risk of CVD. The objectives were to enhance stakeholder engagement; to implement the intervention in four research sites and to evaluate the use of Voluntary and Community and Social Enterprises (VCSE) and Community Health Worker (CHW) partnerships in health interventions. Methods: A type three hybrid implementation study design was used with mixed methods data. This paper represents the process evaluation of the implementation of the SPICES-Sussex Project. The evaluation was conducted using the RE-AIM framework. Results: Reach: 381 individuals took part in the risk profiling questionnaire and forty-one women, and five men participated in the coaching intervention. Effectiveness: quantitative results from intervention participants showed significant improvements in CVD behavioural risk factors across several measures. Qualitative data indicated high acceptability, with the holistic, personalised, and person-centred approach being valued by participants. Adoption: 50% of VCSEs approached took part in the SPICES programme, The CHWs felt empowered to deliver high-quality and mutually beneficial coaching within a strong project infrastructure that made use of VCSE partnerships. Implementation: Co-design meetings resulted in local adaptations being made to the intervention. 29 (63%) of participants completed the intervention. Practical issues concerned how to embed CHWs in a health service context, how to keep engaging participants, and tensions between research integrity and the needs and expectations of those in the voluntary sector. Maintenance: Several VCSEs expressed an interest in continuing the intervention after the end of the SPICES programme. Conclusion: Community-engagement approaches have the potential to have positively impact the health and wellbeing of certain groups. Furthermore, VCSEs and CHWs represent a significant untapped resource in the UK. However, more work needs to be done to understand how links between the sectors can be bridged to deliver evidence-based effective alternative preventative healthcare. Reaching vulnerable populations remains a challenge despite partnerships with VCSEs which are embedded in the community. By showing what went well and what did not, this project can guide future work in community engagement for health.
ABSTRACT
BACKGROUND.: Community-led health care interventions may be an effective way to tackle cardiovascular disease (CVD) risk factors, especially in materially deprived communities where health care resources are stretched and engagement with institutions is often low. To do so effectively and equitably, interventions might be developed alongside community members through community engagement. OBJECTIVES.: The aim of this project was to carry out stakeholder mapping and partnership identification and to understand the views, needs, experiences of community members who would be involved in later stages of a community-based CVD prevention intervention's development and implementation. METHODS.: Stakeholder mapping was carried out to identify research participants in three communities in Sussex, United Kingdom. A qualitative descriptive approach was taken during the analysis of focus groups and interviews with 47 participants. FINDINGS.: Three themes were highlighted related to intervention design (a) Management: the suitability of the intervention for the community, management of volunteers, and communication; (b) Logistics: the structure and design of the intervention; and (c) Sociocultural issues, the social and cultural expectations/experiences of participants and implementers. CONCLUSIONS.: Study participants were open and willing to engage in the planned community-based intervention, particularly in elements of co-design and community-led delivery. They also highlighted the importance of sociocultural factors. Based on the findings, we developed recommendations for intervention design which included (but were not limited to): (a) a focus on a bottom-up approach to intervention design, (b) the recruitment of skilled local volunteers, and (c) the importance of fun and simplicity.
ABSTRACT
Around a quarter of the population report "mirror pain" experiences in which bodily sensations of pain are elicited in response to viewing another person in pain. We have shown that this population of responders further fractionates into two distinct subsets (Sensory/localized and Affective/General), which presents an important opportunity to investigate the neural underpinnings of individual differences in empathic responses. Our study uses fMRI to determine how regions involved in the perception of pain interact with regions implicated in empathic regulation in these two groups, relative to controls. When observing pain in others (minor injuries to the hands and feet), the two responder groups show activation in both the sensory/discriminative and affective/motivational components of the pain matrix. The control group only showed activation in the latter. The two responder groups showed clear differences in functional connectivity. Notably, Sensory/Localized responders manifest significant coupling between the right temporo-parietal junction (rTPJ) and bilateral anterior insula. We conclude that conscious experiences of vicarious pain is supported by specific patterns of functional connectivity between pain-related and regulatory regions, and not merely increased activity within the pain matrix itself.
ABSTRACT
Vicarious pain perception has been an influential paradigm for investigating the social neuroscience of empathy. This research has highlighted the importance of both shared representations (i.e., involved in both experiencing first-hand physical pain and observing pain) and mechanisms that discriminate between self and other. The majority of this research has been conducted in healthy younger adults using a group-average approach. There are, however, known inter-individual differences that can contribute to vicarious experience. One factor relates to the degree to which individuals experience reportable pain-like sensations/feelings in response to seeing others in pain. Here we conduct the first systematic investigation of the neural basis of conscious vicarious pain in a large sample of participants. Using cluster analysis, we firstly demonstrate that consciously experiencing the pain of others is surprisingly prevalent and, exists in two forms: one group experiences sensory and localised pain whilst the other group report affective and non-localised experiences. Building on this, we used electroencephalography (EEG) and structural brain imaging to examine the neural correlates of vicarious pain in the three different groups. We find that the dominant electrophysiological marker used to index vicarious pain in previous studies (mu and beta suppression) was only found to be significant in the sensory and localised pain responder group (with a sensitive null result in the 'neurotypical' group). Finally, using voxel-based morphometry (VBM) we identify a common differences in the two pain responder groups relative to typical adults; namely increased grey-matter in insula and somatosensory cortex and reduced grey matter in the right temporo-parietal junction (rTPJ). We suggest that the latter reflects a reduced ability to distinguish bodily self and other, and may be a common factor distinguishing conscious from unconscious vicarious experience.
