El Niño Southern Oscillation, monsoon anomaly, and childhood diarrheal disease morbidity in Nepal.

Climate change is adversely impacting the burden of diarrheal diseases. Despite significant reduction in global prevalence, diarrheal disease remains a leading cause of morbidity and mortality among young children in low- and middle-income countries. Previous studies have shown that diarrheal disease is associated with meteorological conditions but the role of large-scale climate phenomena such as El Niño-Southern Oscillation (ENSO) and monsoon anomaly is less understood. We obtained 13 years (2002-2014) of diarrheal disease data from Nepal and investigated how the disease rate is associated with phases of ENSO (El Niño, La Niña, vs. ENSO neutral) monsoon rainfall anomaly (below normal, above normal, vs. normal), and changes in timing of monsoon onset, and withdrawal (early, late, vs. normal). Monsoon season was associated with a 21% increase in diarrheal disease rates (Incident Rate Ratios [IRR]: 1.21; 95% CI: 1.16-1.27). El Niño was associated with an 8% reduction in risk while the La Niña was associated with a 32% increase in under-5 diarrheal disease rates. Likewise, higher-than-normal monsoon rainfall was associated with increased rates of diarrheal disease, with considerably higher rates observed in the mountain region (IRR 1.51, 95% CI: 1.19-1.92). Our findings suggest that under-5 diarrheal disease burden in Nepal is significantly influenced by ENSO and changes in seasonal monsoon dynamics. Since both ENSO phases and monsoon can be predicted with considerably longer lead time compared to weather, our findings will pave the way for the development of more effective early warning systems for climate sensitive infectious diseases.

The Role of Health Literacy in Family Planning Use among Senegalese Women.

Health communication has contributed to an increase in family planning use through education and mass media as a means to increase health literacy. In this research, we investigate health literacy as an auxiliary component of health communication. We test the validity of the Health Literacy Skills Framework by examining the correlation of health literacy indicators to family planning use among Senegalese women in the 2014 Demographic Health Survey. We found that increased family planning use was most strongly associated with hearing family planning messages through television and radio. Other health literacy indicators, including access to printed family planning messaging, textual literacy, and knowledge of ovulatory cycles did not strengthen family planning use, even when performing a subgroup analysis of women who could read. The implications are that the Health Literacy Skills framework can measure health literacy's ability (assessed through proxy indicators of health literacy) to predict modern family planning use among Senegalese women and that audio and visual health literacy measures are most strongly associated with increased family planning use.

Web-based versus in-person methods for training lay community health advisors to implement health promotion workshops: participant outcomes from a cluster-randomized trial.

Project HEAL (Health through Early Awareness and Learning) is an implementation trial that compared two methods of training lay peer community health advisors (CHAs)-in-person ("Traditional") versus web-based ("Technology")-to conduct a series of three evidence-based cancer educational workshops in African American churches. This analysis reports on participant outcomes from Project HEAL. Fifteen churches were randomized to the two CHA training methods and the intervention impact was examined over 24 months. This study was conducted in Prince George's County, MD, and enrolled 375 church members age 40-75. Participants reported on knowledge and screening behaviors for breast, prostate, and colorectal cancer. Overall, cancer knowledge in all areas increased during the study period (p < .001). There were significant increases in digital rectal exam (p < .05), fecal occult blood test (p < .001), and colonoscopy (p < .01) at 24 months; however, this did not differ by study group. Mammography maintenance (56% overall) was evidenced by women reporting multiple mammograms within the study period. Participants attending all three workshops were more likely to report a fecal occult blood test or colonoscopy at 24 months (p < .05) than those who attended only one. These findings suggest that lay individuals can receive web-based training to successfully implement an evidence-based health promotion intervention that results in participant-level outcomes comparable with (a) people trained using the traditional classroom method and (b) previous efficacy trials. Findings have implications for resources and use of technology to increase widespread dissemination of evidence-based health promotion interventions through training lay persons in community settings.

Assessing Capacity of Faith-Based Organizations for Health Promotion Activities.

BACKGROUND: Faith-based organizations (FBOs) are important venues for health promotion, particularly in medically underserved communities. These organizations vary considerably in their structural capacities, which may be linked to variability in implementation success for health promotion initiatives. Lacking an existing validated assessment of organizational capacity specific to FBOs, an initial prototype assessment was developed. METHOD: The Faith-Based Organization Capacity Inventory (FBO-CI) assesses three structural areas of capacity: Staffing and Space, Health Promotion Experience, and External Collaboration. The multidisciplinary team, including FBO leaders, codeveloped the initial instrument. The initial reliability from a convenience sample of 34 African American churches including descriptions of FBOs representing three capacity levels is reported. RESULTS: The FBO-CI demonstrated feasibility of administration using an in-person interview format, and the three subscales had acceptable internal reliability (α ~ .70). Most churches had an established health ministry (n = 23) and had conducted activities across an average of seven health areas in the previous 2 years. CONCLUSIONS: This initial FBO-CI prototype is promising, and future work should consider validation with a larger sample of churches and domain expansion based on the conceptual model. The FBO-CI has a number of potential uses for researchers, FBO leaders, and practitioners working with FBOs in health promotion initiatives.

Adoption, reach, and implementation of a cancer education intervention in African American churches.

BACKGROUND: Use of technology is increasing in health promotion and has continued growth potential in intervention research. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this paper reports on the adoption, reach, and implementation of Project HEAL (Health through Early Awareness and Learning)-a community-based implementation trial of a cancer educational intervention in 14 African American churches. We compare adoption, reach, and implementation at the organizational and participant level for churches in which lay peer community health advisors (CHAs) were trained using traditional classroom didactic methods compared with a new online system. METHODS: Fifteen churches were randomized to one of two study groups in which two CHAs per church were trained through either classroom ("Traditional"; n = 16 CHAs in 8 churches) or web-based ("Technology"; n = 14 CHAs in 7 churches) training methods. Once trained and certified, all CHAs conducted a series of three group educational workshops in their churches on cancer early detection (breast, prostate, and colorectal). Adoption, reach, and implementation were assessed using multiple data sources including church-level data, participant engagement in the workshops, and study staff observations of CHA performance. RESULTS: The project had a 41% overall adoption rate at the church level. In terms of reach, a total of 375 participants enrolled in Project HEAL-226 participants in the Traditional group (43% reach) and 149 in the Technology group (21% reach; p < .10). Implementation was evaluated in terms of adherence, dosage, and quality. All churches fully completed the three workshops; however, the Traditional churches took somewhat longer (M = 84 days) to complete the workshop series than churches in the Technology group (M = 64 days). Other implementation outcomes were comparable between both the Traditional and Technology groups (p > .05). CONCLUSIONS: Overall, the Project HEAL intervention had reasonable adoption, though reach could have been better. Implementation was strong across both study groups, suggesting the promise of using web-based methods to disseminate and implement evidence-based interventions in faith-based settings and other areas where community health educators work to eliminate health disparities.

Translating evidence-based interventions for implementation: Experiences from Project HEAL in African American churches.

BACKGROUND: Community-based approaches have been increasing in the effort to raise awareness and early detection for cancer and other chronic disease. However, many times, such interventions are tested in randomized trials, become evidence-based, and then fail to reach further use in the community. Project HEAL (Health through Early Awareness and Learning) is an implementation trial that aims to compare two strategies of implementing evidence-based cancer communication interventions in African American faith-based organizations. METHOD: This article describes the community-engaged process of transforming three evidence-based cancer communication interventions into a coherent, branded strategy for training community health advisors with two delivery mechanisms. Peer community health advisors receive training through either a traditional classroom approach (with high technical assistance/support) or a web-based training portal (with low technical assistance/support). RESULTS: We describe the process, outline the intervention components, report on the pilot test, and conclude with lessons learned from each of these phases. Though the pilot phase showed feasibility, it resulted in modifications to data collection protocols and team and community member roles and expectations. CONCLUSIONS: Project HEAL offers a promising strategy to implement evidence-based interventions in community settings through the use of technology. There could be wider implications for chronic disease prevention and control.

The effect of seeing a family physician on the level of glycosylated hemoglobin (HbA1c) in type 2 Diabetes Mellitus patients.

BACKGROUND: Glycosylated hemoglobin (HbA1c) in diabetic patients reflects the average blood glucose level, and will not be affected by variability in blood glucose in short time. Regular care of patients by medical staff could effectively control glycemic situation. The aim of this study was to assess the effect of medical care by general physicians on glycemic control by measuring of HbA1c. METHODS: In order to assess the effectiveness of National program for diabetes control and prevention in Iran, we compare HbA1c, Fasting blood glucose (FBS), systolic and diastolic blood pressure in two groups of diabetic patients diagnosed in this program. The first group consisted of patients who received at least four visits by General Physician (GP) during one year after the diagnosis, and second group were patients who did not visited by GPs or received 1-3 visits. RESULTS: After one year, 24.1% of patients did not receive any care, while 57.9% examined at least once a year. Among visited patients, 23.5% received 1-3 times medical care and 23.5% received four or more visits. HbA1c was significantly lowered in patients with appropriate care (four and more) compared with the non cared patients and patients with less than four cares. CONCLUSION: Appropriate number of visits for each patient by GPs is an effective glycemic control in diabetic patients. Although this study provides a framework for medical care in diabetes, how to take care of these patients depends on specific situation of each patient and should be determined for each of them individually.

Analysis of avian influenza with special focus on Pakistan.

Over the centuries, many pandemics have come and gone, ranging from plagues to the recent waves of influenza, and have left swathes of destruction all over the world. Most recently, a relatively new pandemic, Avian Influenza, has emerged and is resulting in innumerable amounts of damage on a global scale. Already responsible for the deaths of tens of millions of livestock and wild birds, billions of dollars in damages, and hundreds of human deaths, the pandemic has spread through Asia and is continuing its move westward. With new cases being presented in various countries, the continuous loss of animal life, and the increasing vulnerability to the disease of human populations, governments worldwide have begun taking initiatives to prevent the spread, transmission, and deaths resulting from Avian Influenza. In late 2007, the Federal Government of Pakistan created the National Program for the Control and Prevention of Avian Influenza (NPCPAI). Following the completion of two focus group discussions involving 51 women from the Mansehra District, data indicated that with the recent outbreak of such a dangerous disease, many communities were not informed as to how to prevent the spread and transmission of Avian Influenza. As a result of government-sponsored interventions, through the use of training sessions involving the dissemination of all necessary information regarding Avian Influenza, the individuals who had taken part in the training were much more likely than the uninformed groups to be able to spot the disease, prevent its transmission to other livestock, decontaminate infected areas, and prevent contraction of the disease by themselves and their families. As a result of the success of this program, recommendations for the future include widespread awareness campaigns using mass media resources, training sessions dispersed throughout the regions, and increased funding for current and future projects involving research on prevention and treatment for Avian Influenza.

Bangladesh HIV/AIDS communication challenges and strategies.

Bangladesh is in a precarious position in relation to the HIV/AIDS epidemic. Rates are currently low compared to the rest of the South Asian region, and the disease is relatively confined to small, high-risk populations--mainly injection drug users (IDUs) and commercial sex workers. Yet if steps are not taken quickly to keep the epidemic in check, it could easily spread to the general population as it has in other countries nearby. This would both increase the negative impact of HIV/AIDS and make it much harder to target for containment. It is therefore imperative that healthy behavior be promoted among IDUs and sex users, not only for their own health, but for the health of the country. Prevention will be the key to halting the spread of HIV infection through the implementation of communication and education programs aimed to change high-risk behavior. However, the disparate number of HIV/AIDS prevention programs independently operating in Bangladesh combined with the difficulty in adequately targeting this unique population of IDUs and sex workers establishes a complex situation where attaining behavior change is extremely difficult. This paper proposes adoption of the FOMENT model to design a health communication campaign targeting the high-risk populations in Bangladesh.

Forty years of diffusion of innovations: utility and value in public health.

This special issue is created to mark the 40th anniversary of Everett Rogers' Diffusion of Innovations (DOI) model. Diffusion is the process through which an innovation, defined as an idea perceived as new, spreads via certain communication channels over time among the members of a particular social system. A great deal of research in a variety of academic disciplines (about 5000 published studies so far) has been conducted on the diffusion of innovations over the past six decades. The areas of application for these studies range from hybrid seed corn to modern math, to the snowmobile to antibiotic drugs, to HIV/AIDS prevention (Rogers, 1995). These investigations have led to a general model of the diffusion of innovations, which can be applied to the recent spread of the Internet or to any other new idea. Everett Roger's ground-breaking model has contributed to a greater understanding of behavioral change, including the variation in rates of adoption of innovations, and it has held a broad scope of practical applications in the field of public health.