Linking communities and health facilities to improve child health in low-resource settings: a systematic review.

Community-facility linkage interventions are gaining popularity as a way to improve community health in low-income settings. Their aim is to create/strengthen a relationship between community members and local healthcare providers. Representatives from both groups can address health issues together, overcome trust problems, potentially leading to participants' empowerment to be responsible for their own health. This can be achieved via different approaches. We conducted a systematic literature review to explore how this type of intervention has been implemented in rural and low or lower-middle-income countries, its various features and how/if it has helped to improve child health in these settings. Publications from three electronic databases (Web of Science, PubMed and Embase) up to 03 February 2022 were screened, with 14 papers meeting the inclusion criteria (rural setting in low/lower-middle-income countries, presence of a community-facility linkage component, outcomes of interest related to under-5 children's health, peer-reviewed articles containing original data written in English). We used Rosato's integrated conceptual framework for community participation to assess the transformative and community-empowering capacities of the interventions, and realist principles to synthesize the outcomes. The results of this analysis highlight which conditions can lead to the success of this type of intervention: active inclusion of hard-to-reach groups, involvement of community members in implementation's decisions, activities tailored to the actual needs of interventions' contexts and usage of mixed methods for a comprehensive evaluation. These lessons informed the design of a community-facility linkage intervention and offer a framework to inform the development of monitoring and evaluation plans for future implementations.

Community development in the production of concentrated flourhigh in amino acids made from a combination of eel and tempe / Desarrollo comunitario en la producción de harina concentrada rica en aminoácidos a partir de una combinación de anguila y tempe

Introduction and Objectives: To date, there are no known supplement products made from a combination of eel and tempe. The development of concentrate from eels in combination with tempe (ETF) aims to create supplements containing the essential amino acid L-arginine, which has many proven health benefits. Methods: The community empowerment was held from June to July 2023 at Cangkringan, Sleman, Yogyakarta. The main agendas consisted of ETF training production and the cooking creation of ETF-based food. Aside from that, there were several secondary agendas such as food halal socialization, accessories design training, patchwork utilization training, computer and Microsoft Office training, English language education, public speaking class, Al-Qur’an and miscellaneous education for children, community service, mutual cinema, and competitions for the community. Results: The community development program in the production of high-amino acid concentrated ETF flour has succeeded in achieving the three main objectives of the program, namely functional product innovation, empowerment of micro, small, and medium enterprises and local communities, as well as increasing demand for local commodities, showing the importance of collaboration between the government, community, and private sector in supporting the development of local products that are economically and health-beneficial and can be used as examples to share similar initiatives in other areas.(AU)

Implementation framework for income generating activities identified by community health volunteers (CHVs): a strategy to reduce attrition rate in Kilifi County, Kenya.

BACKGROUND: Despite the proven efficacy of Community Health Volunteers (CHVs) in promoting primary healthcare in low- and middle-income countries (LMICs), they are not adequately financed and compensated. The latter contributes to the challenge of high attrition rates observed in many settings, highlighting an urgent need for innovative compensation strategies for CHVs amid budget constraints experienced by healthcare systems. This study sought to identify strategies for implementing Income-Generating Activities (IGAs) for CHVs in Kilifi County in Kenya to improve their livelihoods, increase motivation, and reduce attrition. METHODS: An exploratory qualitative research study design was used, which consisted of Focus group discussions with CHVs involved in health promotion and data collection activities in a local setting. Further, key informant in-depth interviews were conducted among local stakeholder representatives and Ministry of Health officials. Data were recorded, transcribed and thematically analysed using MAXQDA 20.4 software. Data coding, analysis and presentation were guided by the Okumus' (2003) Strategy Implementation framework. RESULTS: A need for stable income was identified as the driving factor for CHVs seeking IGAs, as their health volunteer work is non-remunerative. Factors that considered the local context, such as government regulations, knowledge and experience, culture, and market viability, informed their preferred IGA strategy. Individual savings through table-banking, seeking funding support through loans from government funding agencies (e.g., Uwezo Fund, Women Enterprise Fund, Youth Fund), and grants from corporate organizations, politicians, and other donors were proposed as viable options for raising capital for IGAs. Formal registration of IGAs with Government regulatory agencies, developing a guiding constitution, empowering CHVs with entrepreneurial and leadership skills, project and group diversity management, and connecting them to support agencies were the control measures proposed to support implementation and enhance the sustainability of IGAs. Group-owned and managed IGAs were preferred over individual IGAs. CONCLUSION: CHVs are in need of IGAs. They proposed implementation strategies informed by local context. Agencies seeking to support CHVs' livelihoods should, therefore, engage with and be guided by the input from CHVs and local stakeholders.

Individual perceptions of community efficacy for non-communicable disease management in twelve communities in China: cross-sectional and longitudinal analyses.

OBJECTIVES: This objective of this study was to use empirical data to assess cross-sectional variation singular and changes over time in community efficacy for non-communicable diseases (NCDs) management (COEN) and to examine individual factors associated with changes in COEN. STUDY DESIGN: This was a longitudinal observational study. METHODS: Participants with hypertension and diabetes were randomly selected from 12 communities from three cities in eastern China, and a baseline survey and a 1-year follow-up were conducted. The COEN scale has five dimensions: community physical environment (CPE), behavioral risk factors (BRF), mental health and social relationships (MHSR), community health management (CHM), and community organisations and activities (COA). Mixed-effects models were used to investigate the change in COEN over time and the association between individual factors and changes in COEN. RESULTS: COEN scores showed significant variation singular among the 12 communities (P < 0.001) at the baseline. In the mixed-effects model, CPE (ß coefficient: 1.62, P < 0.001), BRF (0.90, P < 0.001), MHSR (0.86, P < 0.001), CHM (0.46, P < 0.001), and total scores (ß = 3.57, P < 0.001) increased significantly over time. The changes in COEN were associated with individual characteristics (e.g., older, men, more educated). CONCLUSIONS: Cross-sectional variations and changes over time in COEN demonstrated the utility of a sensitive instrument. Factors such as age, gender, marriage, education level, and employment may affect the financial and social resources assignment for NCD management. Our findings suggest that further high-quality studies are needed to better evaluate the effect of community empowerment on the prevention and control of NCDs.

Investigating health and social outcomes of the Big Local community empowerment initiative in England: a mixed method evaluation.

Background: Most research on community empowerment provides evidence on engaging communities for health promotion purposes rather than attempts to create empowering conditions. This study addresses this gap. Intervention: Big Local started in 2010 with £271M from the National Lottery. Ending in 2026, it gives 150 relatively disadvantaged communities in England control over £1M to improve their neighbourhoods. Objective: To investigate health and social outcomes, at the population level and among engaged residents, of the community engagement approach adopted in a place-based empowerment initiative. Study design, data sources and outcome variables: This study reports on the third wave of a longitudinal mixed-methods evaluation. Work package 1 used a difference-in-differences design to investigate the impact of Big Local on population outcomes in all 150 Big Local areas compared to matched comparator areas using secondary data. The primary outcome was anxiety; secondary outcomes included a population mental health measure and crime in the neighbourhood. Work package 2 assessed active engagement in Big Local using cross-sectional data and nested cohort data from a biannual survey of Big Local partnership members. The primary outcome was mental well-being and the secondary outcome was self-rated health. Work package 3 conducted qualitative research in 14 Big Local neighbourhoods and nationally to understand pathways to impact. Work package 4 undertook a cost-benefit analysis using the life satisfaction approach to value the benefits of Big Local, which used the work package 1 estimate of Big Local impact on life satisfaction. Results: At a population level, the impacts on 'reporting high anxiety' (-0.8 percentage points, 95% confidence interval -2.4 to 0.7) and secondary outcomes were not statistically significant, except burglary (-0.054 change in z-score, 95% confidence interval -0.100 to -0.009). There was some effect on reduced anxiety after 2017. Areas progressing fastest had a statistically significant reduction in population mental health measure (-0.053 change in z-score, 95% confidence interval -0.103 to -0.002). Mixed results were found among engaged residents, including a significant increase in mental well-being in Big Local residents in the nested cohort in 2018, but not by 2020; this is likely to be COVID-19. More highly educated residents, and males, were more likely to report a significant improvement in mental well-being. Qualitative accounts of positive impacts on mental well-being are often related to improved social connectivity and physical/material environments. Qualitative data revealed increasing capabilities for residents' collective control. Some negative impacts were reported, with local factors sometimes undermining residents' ability to exercise collective control. Finally, on the most conservative estimate, the cost-benefit calculations generate a net benefit estimate of £64M. Main limitations: COVID-19 impacted fieldwork and interpretation of survey data. There was a short 4-year follow-up (2016/20), no comparators in work package 2 and a lack of power to look at variations across areas. Conclusions: Our findings suggest the need for investment to support community organisations to emerge from and work with communities. Residents should lead the prioritisation of issues and design of solutions but not necessarily lead action; rather, agencies should work as equal partners with communities to deliver change. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research Programme (16/09/13) and will be published in full in Public Health Research; Vol. 11, No. 9. See the NIHR Journals Library website for further project information.

The Communities in Control study is looking at the health impacts of the Big Local community empowerment programme, funded by the National Lottery Community Fund and managed by Local Trust (a national charitable organisation). Residents of 150 English areas have at least £1M and other support to improve the neighbourhoods. There have been three phases of the research. This report shares findings from their third phase, which began in 2018. First, we used data from a national survey and data from national health and welfare services to compare changes in mental health between people living in Big Local areas and those in similar areas that did not have a Big Local partnership. Furthermore, we also used publicly available data on crime in the neighbourhoods. We found weak evidence that Big Local was linked with improved mental health and a reduction in burglaries. Second, we used data from a survey conducted by Local Trust to look at health and social impacts on the most active residents. We found an increase in mental well-being in 2018 but this was not maintained in 2020, probably due to the COVID-19 pandemic. Third, we did interviews and observations in 14 Big Local areas to understand what helps and what does not help residents to improve their neighbourhoods. We found that partnerships need to have legitimacy, the right balance of support, and learning opportunities. Residents suggested that creating social connections and welcoming social spaces, improving how people view the area and tackling poverty contributed to health improvements. Direct involvement in Big Local was both stressful and rewarding. Finally, we did a cost­benefit analysis by putting a monetary value on residents' increase in life satisfaction due to Big Local and comparing it with the costs of Big Local. We found that the benefits exceed the costs by at least £60M, suggesting that Big Local provides good value for money.

Exposure to the Family Wellbeing program and associations with empowerment, health, family and cultural wellbeing outcomes for Aboriginal and Torres Strait Islander peoples: a cross-sectional analysis.

BACKGROUND: Empowerment is an internationally recognised concept commonly incorporated in First Nations and in this instance Aboriginal and Torres Strait Islander health and wellbeing programs. The Family Wellbeing Program is an empowerment program developed in partnership with Aboriginal and Torres Strait Islander peoples that has been widely delivered to Aboriginal and Torres Strait Islander communities across Australia for close to 30 years. To date, there has been limited quantitative analysis of how this program is linked to health and empowerment outcomes. METHODS: Cross sectional analysis of Mayi Kuwayu, the National Study of Aboriginal and Torres Strait Islander Wellbeing, baseline data (n = 9,843) recruited using multi-mode random sampling including mail out survey and in community convenience sampling. Logistic regression models were performed to calculate Prevalence Ratios (PRs) and 95% Confidence Intervals (CIs) to examine the association between personal control, life satisfaction, general health, family wellbeing and cultural wellbeing outcomes for Family Wellbeing participants (n = 718) versus non-participants (n = 9,125). RESULTS: Compared with non-FWB participants, FWB participants are more likely to be female (67.1% versus 58.4%), be aged 35-54 (41.8% versus 32.0%) and live in a remote area (17.7% versus 10.4%) and have educational attainment at the Year 12 level or above (57.8% versus 53.2%). Family Wellbeing participation was associated with a 13% higher reporting of family functioning, a 74% higher reporting of cultural participation and a 21% in higher reporting of local decision making in the local community compared to non-FWB participants. There were significant associations between FWB exposure compared to non-FWB exposure including reporting lower levels of health risk factors including quitting alcohol (26.4% versus 20.4%), regular exercise (67.7% versus 66.3%), quitting smoking (33.4% versus 31.9%). and e. FWB participants who had experienced both prison and youth detention were nearly double that of Non-FWB (3.5% versus 1.4%) and more reported being removed from their families as children (Stolen) (7.0% versus 4.1% Non-FWB). CONCLUSION: There are significant associations between Family Wellbeing exposure and organisation and community level empowerment outcomes, but only for some individual level empowerment outcomes. There is a lower reporting health risk factors including increased physical exercise, reduced alcohol use and smoking; and educational attainment among FWB participants compared to non-FWB participants. The results suggest individual, community and organisational empowerment needs to be explored further with more robust study designs that can attribute causality and direction of association.

Effectiveness of a Community Empowerment Intervention to Improve Access to Pre-exposure Prophylaxis in Migrant Women Sex Workers: Protocol for a Mixed Methods Implementation Study.

BACKGROUND: The World Health Organization recommends pre-exposure prophylaxis (PrEP) for all populations at substantial risk of HIV infection. However, at-risk women very rarely use PrEP in France-this represents a critical issue among migrant women sex workers (MWSWs). Previous studies on PrEP use among women sex workers or migrants focused on individual or social determinants of motivation. However, operational studies in real-word settings using a holistic population approach to maximize PrEP adherence among MWSWs are lacking. OBJECTIVE: FASSETS (ie, "Favoriser l'Accès à la Santé Sexuelle des Travailleuses du Sexe"; English: "facilitate the access to Sexual Health in women sex workers") is a participative, multilevel, mixed methods study aiming to improve global knowledge of and access to sexual health care and PrEP among MWSWs through targeted empowerment strategies. METHODS: This study comprises several phases: (1) phase 1: an initial qualitative study combining semistructured interviews, informal interviews, and participative observations will be performed among MWSWs, local community nongovernmental organizations, and institutions providing sexual reproductive health services to identify the determinants of PrEP access among MWSWs and for respondent-driven sampling (RDS); (2) phase 2: the size of the hidden MWSW population is estimated in Marseille through capture-recapture (the RDS survey will serve as "recapture"); (3) phase 3: a longitudinal cohort will be formed through RDS to represent the MWSW population with a goal of 150 inclusions-this cohort will be followed up for 12 months, and sequential questionnaires exploring medical history; knowledge of sexual health, HIV, and sexually transmitted infections; migration route; and current living conditions will be administered at inclusion (month 0) and months 3, 6, and 12 to measure the following interventional phase's outcomes; and (4) phase 4: an interventional study with community empowerment actions about sexual health and PrEP will be conducted with community health workers; standardized questionnaires and semistructured interviews, observations, and focus groups will highlight MWSWs' experiences with empowerment resources, concerns about sexual health, and especially PrEP use or uptake, and we will evaluate whether and how community-adapted empowerment actions conducted by community health workers are effective in increasing access to sexual health, prevention and screening of sexually transmitted infections, and PrEP knowledge and access among MWSWs. RESULTS: Recruitment commenced on March 1, 2022. We estimate the follow-up period to end on September 30, 2023. CONCLUSIONS: This multiphase study will provide robust evidence about the magnitude of the MWSW population in Marseille (the second largest town in France) and their current conditions of living, access to and knowledge of sexual health, and PrEP access. Using a mixed methods analysis, we will investigate whether individual and collective community health empowerment approaches can facilitate access to PrEP and its initiation, use, and adherence in this vulnerable population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/42844.

Community Empowerment Assessment and Community Nursing Diagnosis for Climate Change Mitigation and Adaptation in the Northern Region of the Portuguese Atlantic Coast: A Mixed-Methods Study Using MAIEC Framework.

The Community Intervention and Empowerment Assessment Model (MAIEC) offers a framework for community empowerment in several fields such as Climate Change (CC), the largest health emergency crisis globally, through diagnosis and interventions in Community Health Nursing. This study aims to assess the level of community empowerment in climate change mitigation and adaptation, and to identify nursing diagnosis through the MAIEC clinical decision matrix, within a local intermunicipal association in the northern region of the Portuguese Atlantic Coast. A convergent mixed-methods design was used, applying a focus group technique to a purposive sampling of ten key stakeholders of this community. A Portuguese version of the Empowerment Assessment Rating Scale and a questionnaire were both applied to the same participants, and qualitative and quantitative data generated were analysed using a content analysis technique and an Excel database sheet created using Microsoft Office 365. The analysis of the Portuguese northern community exposed: a low level of community empowerment for mitigation and adaptation to climate change; a nursing diagnosis of community management impairments in several dimensions, such as community process, community participation and community leadership. However, the study confirmed that MAIEC contributed to future community-based solutions, responding to the challenges of climate change, and enabling the planning of interventions to address MAIEC diagnoses in the form of CC-specific training and recommendations for new cooperation approaches from all stakeholders. This study was not registered.

Vigilância epidemiológica dos diagnósticos de enfermagem: qual a realidade no agrupamento de centros de saúde do Alto Minho? / Epidemiological surveillance of nursing diagnoses: what is the reality in the Alto Minho cluster of health centres?

O presente trabalho surge no âmbito da Unidade Curricular: Estágio de Natureza Profissional com Relatório Final, inserido no plano curricular do II Curso de Mestrado em Enfermagem Comunitária, da Escola Superior de Saúde, do Instituto Politécnico de Viana do Castelo. Este tem como principal finalidade a análise critico-reflexiva da investigação e das atividades realizadas durante o estágio estruturantes do desenvolvimento simultaneamente de competências conducentes à obtenção ao grau de mestre em Enfermagem Comunitária e das competências comuns e especificas à obtenção posteriormente, do título profissional de Enfermeiro Especialista em Enfermagem Comunitária (EEEC), na área da Enfermagem de Saúde Comunitária e de Saúde Pública, atribuído pela Ordem dos Enfermeiros (OE). Decorreu no período de 1 de março a 31 de agosto de 2022. O desenvolvimento deste percurso, teve como problemática central a vigilância epidemiológica dos diagnósticos de enfermagem (VEDE), a partir de uma Unidade de Saúde Pública (USP), tendo como alvo o processo de cuidados prestados pelos enfermeiros do Agrupamento de Centros de Saúde (ACeS) da região norte. Para a compreensão desta realidade e do potencial de intervenção que lhe está inerente recorreu-se ao Modelo de Avaliação, Intervenção e Empoderamento Comunitário (MAIEC, Pedro Melo, 2016). Assim, tendo como objetivo principal conhecer a realidade da VEDE no ACeS, onde se realizou o estágio, realizou-se um estudo observacional, transversal e descritivo, num universo de 262 enfermeiros, sendo a amostra constituída por 77 enfermeiros. A partir da análise documental do Diagnóstico Local de Saúde e do Plano Local de Saúde do ACeS, foram identificados os principais fenómenos de enfermagem e determinadas as taxas de documentação dos mesmos por parte dos enfermeiros. Os resultados obtidos evidenciam um nível baixo de documentação dos diagnósticos de enfermagem e avaliação diagnóstica da gestão comunitária do ACeS sobre a VEDE está comprometida em todas as suas dimensões diagnósticas (liderança comunitária, participação comunitária e processo comunitário).

The present work comes within the scope of the Curricular Unit: Internship of a Professional Nature with Final Report, inserted in the curricular plan of the II Master's Course in Community Nursing, of the Superior School of Health, of the Polytechnic Institute of Viana do Castelo. This has as its main purpose the critical-reflexive analysis of the investigation and activities carried out during the structuring stage of the simultaneous development of skills leading to obtaining a master's degree in Community Nursing and common and specific skills to subsequently obtain the professional title of Nurse Specialist in Community Nursing (EEEC), in the area of Community Health Nursing and Public Health, awarded by the Order of Nurses (OE). It took place from March 1 to August 31, 2022. The development of this course had as its central problem the epidemiological surveillance of nursing diagnoses (VEDE), from a Public Health Unit (USP), having as its target the care process provided by nurses from the Grouping of Health Centers (ACeS) in the northern region. In order to understand this reality and the potential for intervention inherent to it, the Model of Evaluation, Intervention and Community Empowerment (MAIEC, Pedro Melo, 2016) was used. Thus, with the main objective of knowing the reality of VEDE in ACeS, where the internship took place, an observational, cross-sectional and descriptive study was carried out, in a universe of 262 nurses, with a sample consisting of 77 nurses. Based on the documental analysis of the Local Health Diagnosis and the Local Health Plan of ACeS, the main nursing phenomena were identified and the rates of documentation of these by nurses were determined. The results obtained show a low level of documentation of nursing diagnoses and diagnostic evaluation of the community management of ACeS on VEDE is compromised in all its diagnostic dimensions (community leadership, community participation and community process).

Building trust: Leadership reflections on community empowerment and engagement in a large urban initiative.

BACKGROUND: Trust is essential for healthy, reciprocal relationships; creating safe environments; engaging in transparent interactions; successfully negotiating power differentials; supporting equity and putting trauma informed approaches into practice. Less is known, however, about the ways that trust-building may be at the forefront of consideration during community capacity building efforts, what trust-building elements are perceived as essential for optimally engaging communities, and what practices might support these efforts. METHODS: The present study examines an evolving understanding of trust-building over the course of 3 years, from qualitative data derived during interviews with nine agency leads from a large and diverse urban community, who are spearheading community-based partnerships to create more trauma-informed communities and foster resiliency. RESULTS: Data reflected fourteen trust-building elements, captured by three themes: 1) Building relationships and engagement (e.g., behavioral practices such as meeting people "where they are at" and creating safe spaces), 2) Embodying core values of trustworthiness (e.g., traits such as being transparent and embodying benevolence), and 3) Sharing decision-making, championing autonomy, and addressing barriers to trust (e.g., collaborative practices such as creating a shared vision and goals and addressing systemic inequities). These trust-building elements are presented in the Community Circle of Trust-Building, which provides an accessible, visual format that can facilitate capacity building efforts within organizations and with the broader community; guide the selection of training opportunities that support healthy interpersonal relationships; and aid in the identification of relevant, supporting frameworks (e.g., health equity, trauma-informed practices, inclusive leadership models). CONCLUSIONS: Community engagement and trust are essential for overall health and well-being, increasing equitable access to resources, and supporting an effective and connected citizenry. These data shed light on opportunities for trust-building and thoughtful engagement among agencies working directly with community members in large urban areas.

A Strategy for Reducing Maternal Mortality in Rural Kenya.

Background: Migori County is categorized among regions with worst maternal survival rates in Kenya. The county's current maternal mortality ratio (MMR) is 673 deaths per 100 000 live births. A need exists for a context-specific strategy to mitigate the persistent high maternal mortalities in rural Kenya. The researchers aimed to develop a strategy for reducing the maternal mortality ratio (MMR) in Migori, Kenya. Methods: An explanatory sequential mixed methods design was utilised. The design was characterised by two separate studies, an initial quantitative followed by a qualitative study. The final phase entailed integration of data from the two separate studies. The findings, extensive literature review and three delays of maternal mortality theoretical framework informed the development of the strategy. Results: The strategy for implementation considered three strategic areas, namely, interventions targeting first delays, interventions targeting second delays, interventions targeting third delays. Conclusion: The priority interventions needed are those that enable: 1) Pregnant mothers to receive quality peripartum care in Migori hospitals, 2) Strengthened and efficient referral systems of obstetric emergencies and 3) Community knowledge empowerment on safe pregnancy and culture shift. These interventions would significantly transform the health-care system towards maternal mortality reduction. The Kenyan government and non-profit organisations should be involved in the implementation of the proposed strategy.

Community organizing during the COVID-19 pandemic: How should we act when it comes to minority communities?

Minority communities have borne a disproportionate burden of adverse health outcomes during the COVID-19 pandemic. Notwithstanding, there is a lack of empirical evidence regarding efforts to reduce health inequalities through community organizing. It is also unclear under what conditions professionals act as external assistance providers for community organizing as part of their role. Through multimethod research conducted among social workers who provide services to ultra-Orthodox minority communities in Israel during the pandemic, this study identified that the combination of critical awareness of social justice, weakened social cohesion, and work environment expectations led professionals to assist communities in their community organizing efforts. These strategies include an intercommunity component-building trust in the community and promoting collective efficacy; an interactional component-creating multidimensional platforms that support action; and a behavioral component-increasing the involvement of communities in decision-making spaces in public arenas. The crucial characteristic of providing assistance and support in community organizing lies in the adoption of cultural perspectives. It requires knowledge about and familiarity with the different types of communities within which the professionals operate. This vital understanding can promote critical awareness among a wide range of professionals to promote health equity at the present time when the pandemic is still ongoing.

Social innovation in health: strengthening Community Systems for Universal Health Coverage in rural areas.

BACKGROUND: In seeking the attainment of Universal Health Coverage (UHC), there has been a renewed emphasis on the role of communities. This article focuses on social innovation and whether this concept holds promise to enhance equity in health services to achieve UHC and serve as a process to enhance community engagement, participation, and agency. METHODS: A cross-country case study methodology was adopted to analyze three social innovations in health in three low- and middle-income countries (LMICs): Philippines, Malawi, and Colombia. Qualitative methods were used in data collection, and a cross-case analysis was conducted with the aid of a simplified version of the conceptual framework on social innovation as proposed by Cajaiba-Santana. This framework proposes four dimensions of social innovation as a process at different levels of action: the actors responsible for the idea, the new idea, the role of the institutional environment, and the resultant changes in the health and social system. RESULTS: The study found that each of the three social innovation case studies was based on developing community capacities to achieve health through community co-learning, leadership, and accountability. The process was dependent on catalytic agents, creating a space for innovation within the institutional context. In so doing, these agents challenged the prevailing power dynamics by providing the communities with respect and the opportunity to participate equally in creating and implementing programs. In this way, communities were empowered; they were not simply participants but became active agents in conceptualizing, implementing, monitoring, and sustaining the social innovation initiatives. CONCLUSION: The study has illustrated how three creative social innovation approaches improved access and quality of health services for vulnerable rural populations and increased agency among the intervention communities. The processes facilitated empowerment, which in turn supported the sustained strengthening of the community system and the achievement of community goals in the domain of health and beyond.

Impact of a CBPR-informed physical activity intervention before and during COVID-19 among women from a disadvantaged neighborhood in Sweden.

Background: Public health practitioners have been striving to reduce the social gradient and promote physical activity among citizens living in disadvantaged neighborhoods. The emergence of the COVID-19 pandemic, which has affected these citizens extensively, has posed a significant challenge to efforts to maintain a physically active lifestyle. Thus, the aim of this study was to explore the impact of a CBPR-informed physical activity intervention before and during the COVID-19 pandemic from the perspective of women from a socially disadvantaged neighborhood. Methods: A total of 34 women participated in a CBPR-informed physical activity intervention previously developed in collaboration with lay health promoters and other citizens from the same neighborhood. Focus group discussions were conducted at four time points, namely, at baseline prior to the intervention, post-intervention, 6 months after the intervention ended, and during the COVID-19 pandemic. The data were analyzed using qualitative content analysis following an inductive approach. Results: In total, four themes emerged from the discussions: "Wavering between frustration and action," "Shifting from prioritizing family needs to taking control of self," "Between isolation and social support," and "Restricted access to health-related knowledge vs. utilizing internalized knowledge". Conclusion: The results of this study reveal that building on CBPR-informed health promotion initiatives has the potential to foster individual empowerment and assist during acute situations like the COVID-19 pandemic through mobilizing communities and their resources, which leads to increased community resilience and health. This study is regarded as unique in that it involves evaluation of a CBPR intervention that was initiated ahead of the pandemic and followed even during the pandemic.

The contribution of peer research in evaluating complex public health interventions: examples from two UK community empowerment projects.

BACKGROUND: Peer-research is steered and conducted by people with lived experience of the issues being researched. This paper explores the value of peer-research in two complex public health intervention evaluations in the UK. METHODS: Reports from 18 peer research projects, completed by residents from 12 communities in the UK taking part in two community empowerment interventions, were analysed using cross-case analysis. RESULTS: Undertaking peer research helped to build the evaluation and research skills within individual projects as well as providing data on other outcomes related to the programmes Theory of Change. Some peer researchers, however, felt unprepared for the activity despite support from the academic team and were unsatisfied with project outcomes. While peer research projects provided more opportunities for local residents to engage with the overall evaluations, there was an overreliance on people closely connected to the programmes to be peer researchers. The peer research projects explored topics that were broader than the aims and objectives of the overall programme evaluations. All provided insight into the context in which projects occurred, while some also informed understanding of programme change mechanisms. CONCLUSIONS: Including peer research as part of complex public health intervention evaluations can help uncover important contextual and ecological details beyond the reach of more traditional evaluation data collection. Peer research can also empower and build research/evaluation capacity within communities, which is particularly pertinent for community empowerment interventions.

Climate Change Prevention through Community Actions and Empowerment: A Scoping Review.

As society tries to tackle climate change around the globe, communities need to reduce its impact on human health. The purpose of this review is to identify key stakeholders involved in mitigating and adapting to climate change, as well as the type and characteristics of community empowerment actions implemented so far to address the problem. Published and unpublished studies from January 2005 to March 2022 in English and Portuguese were included in this review. The search, conducted on PubMed, CINAHL, Scopus, MEDLINE, Scopus, Web of Science, SciELO, and RCAAP (Repositório Científico de Acesso Aberto de Portugal), followed a three-step search strategy. Data extraction was performed by two independent reviewers, using an extraction tool specifically designed for the review questions. Twenty-seven studies were eligible for inclusion: six used interviews as a qualitative method, three were systematic reviews, three were case study analyses, three used surveys and questionnaires as quantitative methods, two used integrative baseline reviews, and three utilized a process model design. Six studies targeted local, public and private stakeholders. Community settings were the context target of fifteen studies, whereas twelve specifically referred to urban settings. Seven types of community actions were acknowledged across the globe, characterised as hybrid interventions and referring to the leading stakeholders: local governments, non-governmental organizations, civil society, universities, public health, and private sectors.

Income and Health Perceptions in an Economically Disadvantaged Community: A Qualitative Case Study from Central Florida.

The link between income and adverse health outcomes continues to be problematic among racially and economically segregated urban communities. Although the consequences of living in areas of concentrated disadvantage have been delineated, there is a dearth of knowledge on how citizens from such areas perceive the effects of neighborhood characteristics on their individual and community health. This qualitative study explored how minority residents ( N = 23) viewed the intersectionality of income and health within their urban neighborhoods of economic distress. Focus groups were conducted using semi-structured interviews to better understand health concerns, needs, and barriers for individuals and their community. The main finding highlighted how residents desired to be healthy, but economic barriers prevented them from maintaining a healthy lifestyle and diet. While residing in a concentrated disadvantaged community, lack of income and power contributed to stress and fear that forced residents to prioritize survival over their wellbeing. Implications for improving individual and community health include operating within a systems framework to affect collective efficacy and empowerment among residents of low-income neighborhoods.

Cultural context in New Zealand: incorporating kaupapa Maori values in clinical research and practice.

We examined the importance of understanding and incorporating cultural context within Aotearoa/New Zealand when engaging in clinical research and practice. This paper reports on the qualitative findings of a mixed methods study aimed at determining what effect a cardiac risk reduction exercise and lifestyle management programme, embedded within a kaupapa Maori methodological approach, had on Maori participants. This methodology saw participants able to redevelop a western model cardiac risk reduction programme by introducing a Maori worldview. Our study revealed how the kaupapa Maori approach empowered participants to examine and evaluate not only their own health and lifestyle choices, but those of family and the wider community. Combining biomedical and kaupapa Maori components into the programme was found to benefit participants' mental, physical, spiritual and family well-being.

MoveApps: a serverless no-code analysis platform for animal tracking data.

BACKGROUND: Bio-logging and animal tracking datasets continuously grow in volume and complexity, documenting animal behaviour and ecology in unprecedented extent and detail, but greatly increasing the challenge of extracting knowledge from the data obtained. A large variety of analysis methods are being developed, many of which in effect are inaccessible to potential users, because they remain unpublished, depend on proprietary software or require significant coding skills. RESULTS: We developed MoveApps, an open analysis platform for animal tracking data, to make sophisticated analytical tools accessible to a global community of movement ecologists and wildlife managers. As part of the Movebank ecosystem, MoveApps allows users to design and share workflows composed of analysis modules (Apps) that access and analyse tracking data. Users browse Apps, build workflows, customise parameters, execute analyses and access results through an intuitive web-based interface. Apps, coded in R or other programming languages, have been developed by the MoveApps team and can be contributed by anyone developing analysis code. They become available to all user of the platform. To allow long-term and cross-system reproducibility, Apps have public source code and are compiled and run in Docker containers that form the basis of a serverless cloud computing system. To support reproducible science and help contributors document and benefit from their efforts, workflows of Apps can be shared, published and archived with DOIs in the Movebank Data Repository. The platform was beta launched in spring 2021 and currently contains 49 Apps that are used by 316 registered users. We illustrate its use through two workflows that (1) provide a daily report on active tag deployments and (2) segment and map migratory movements. CONCLUSIONS: The MoveApps platform is meant to empower the community to supply, exchange and use analysis code in an intuitive environment that allows fast and traceable results and feedback. By bringing together analytical experts developing movement analysis methods and code with those in need of tools to explore, answer questions and inform decisions based on data they collect, we intend to increase the pace of knowledge generation and integration to match the huge growth rate in bio-logging data acquisition.

Empowering local communities using artificial intelligence.

Artificial intelligence (AI) applications can profoundly affect society. Recently, there has been extensive interest in studying how scientists design AI systems for general tasks. However, it remains an open question as to whether the AI systems developed in this way can work as expected in different regional contexts while simultaneously empowering local people. How can scientists co-create AI systems with local communities to address regional concerns? This article contributes new perspectives in this underexplored direction at the intersection of data science, AI, citizen science, and human-computer interaction. Through case studies, we discuss challenges in co-designing AI systems with local people, collecting and explaining community data using AI, and adapting AI systems to long-term social change. We also consolidate insights into bridging AI research and citizen needs, including evaluating the social impact of AI, curating community datasets for AI development, and building AI pipelines to explain data patterns to laypeople.