Complexity and Community Context: Learning from the Evaluation Design of a National Community Empowerment Programme

Community empowerment interventions, which aim to build greater individual and community control over health, are shaped by the community systems in which they are implemented. Drawing on complex systems thinking in public health research, this paper discusses the evaluation approach used for a UK community empowerment programme focused on disadvantaged neighbourhoods. It explores design choices and the tension between the overall enquiry questions, which were based on a programme theory of change, and the varied dynamic socio-cultural contexts in intervention communities. The paper concludes that the complexity of community systems needs to be accounted for through in-depth case studies that incorporate community perspectives

Does involvement in a cohort study improve health and affect health inequalities? A natural experiment

Abstract Background Evidence suggests that the process of taking part in health research can improve participants\u2019 health, independent of any intended intervention. However, no research has yet explored whether these effects differ across socioeconomic groups. If the effect of mere participation in health research also has a social gradient this could increase health inequalities and bias research results. This study used the Born in Bradford family cohort (BIB) to explore whether simply taking part in BIB had improved participants\u2019 health and, if so, whether this effect was mediated by socioeconomic status. Methods Survey data on self-reported health behaviours were collected between 2007 and 2010 as part of BIB. These were augmented by clinical data on birth weight. Pregnant women on their second pregnancy, joining BIB for the first time formed the control group. Their health was compared to women on their second pregnancy who had both pregnancies within the study, who formed the exposed group. In order to limit the inherent bias in a non-randomised study, propensity score analysis was used, matching on age, ethnicity, education and date of questionnaire. The results were then compared according to mothers' education. Results Of six outcomes tested, only alcohol consumption showed a statistically significant reduction with exposure to BIB (OR: 0.35, 95% CIs 0.13, 0.92). Although effect estimates were larger for women with higher education compared to lower education, these effects were not statistically significant. Conclusions Despite one significant finding, these results overall are insufficient to conclude that simply taking part in BIB affected participants\u2019 health. We recommend that socioeconomic status is considered in future studies testing effects of research participation, and that randomised studies with larger sample sizes are conducted

Field investigation with real-time virus genetic characterisation support of a cluster of Ebola virus disease cases in Dubréka, Guinea, April to June 2015

On 11 May 2015, the Dubréka prefecture, Guinea, reported nine laboratory-confirmed cases of Ebola virus disease (EVD). None could be epidemiologically linked to cases previously reported in the prefecture. We describe the epidemiological and molecular investigations of this event. We used the Dubréka EVD registers and the Ebola treatment centre’s (ETC) records to characterise chains of transmission. Real-time field Ebola virus sequencing was employed to support epidemiological results. An epidemiological cluster of 32 cases was found, of which 27 were laboratory confirmed, 24 were isolated and 20 died. Real-time viral sequencing on 12 cases demonstrated SL3 lineage viruses with sequences differing by one to three nt inside a single phylogenetic cluster. For isolated cases, the average time between symptom onset and ETC referral was 2.8 days (interquartile range (IQR): 1–4). The average time between sample collection and molecular results’ availability was 3 days (IQR: 2–5). In an area with scarce resources, the genetic characterisation supported the outbreak investigations in real time, linking cases where epidemiological investigation was limited and reassuring that the responsible strain was already circulating in Guinea. We recommend coupling thorough epidemiological and genomic investigations to control EVD clusters.Peer Reviewe

Who fights, who flees?: An integration of the LC4MP and Psychological Reactance Theory.

This study tests the hypothesis that defensive message processing, like defensive behaviors in the real world, has two directions, fight-and-flight. The Limited Capacity Model of Motivated Mediated Message Processing (LC4MP) characterizes defensive message processing by increases in unpleasantness and arousal reports, and accelerated heart rate indicating either a focus on internal processing (internal thoughts) or the active withdrawal of cognitive resources from processing highly arousing and unpleasant media messages. However, the LC4MP has not included direct measures that allow discrimination between fight-and-flight responses. Psychological reactance theory (PRT) predicts defensive responses including anger and counterarguments (reactance) when media messages threaten viewers’ freedom and autonomy. We hypothesized that PRT provides the LC4MP with the appropriate measures (anger and counterarguments) needed to discriminate fight-or-flight responses. Results supported this prediction. Participants (N = 49 adult-smokers) high in defensive and low in appetitive reactivity (risk-avoiders) withdrew from the message (fled: characterized by low anger and counterarguments) while those high in appetitive and low in defensive reactivity (risk-takers) experienced reactance (fought: characterized by high anger and counterarguments) in response to freedom threatening antitobacco messages that are highly arousing and unpleasant. Moreover, both reactance and message withdrawal yielded the same cognitive, emotional, and physiological responses predicted by the LC4MP as indicators of defensive message processing. Theoretical and message design recommendations are discussed

A Promising Family Literacy Project Based on Male Reading Models

This article discusses an innovative family literacy project that was implemented in a community setting. Male trios consisting of a male relative, a struggling reader in elementary school and a pre-service teacher were created. The goal was 1) to develop student’s motivation to read by using male reading role models and allowing the student to read what he truly enjoys in a non-school environment and 2) document male reading practices as trios. To document the progression of four male trios, we used a semi-directed interview, a focus group and a logbook. The results of this multiple-case research study showed an improvement regarding the student’s motivation to read in the context of male trios, different reading practices inside the trios and a positive evolution in the relationship between the student and participating male relative has been observed

Exploring Young Adults’ Views About Aroha, a Chatbot for Stress Associated With the COVID-19 Pandemic: Interview Study Among Students

BackgroundIn March 2020, New Zealand was plunged into its first nationwide lockdown to halt the spread of COVID-19. Our team rapidly adapted our existing chatbot platform to create Aroha, a well-being chatbot intended to address the stress experienced by young people aged 13 to 24 years in the early phase of the pandemic. Aroha was made available nationally within 2 weeks of the lockdown and continued to be available throughout 2020. ObjectiveIn this study, we aimed to evaluate the acceptability and relevance of the chatbot format and Aroha’s content in young adults and to identify areas for improvement. MethodsWe conducted qualitative in-depth and semistructured interviews with young adults as well as in situ demonstrations of Aroha to elicit immediate feedback. Interviews were recorded, transcribed, and analyzed using thematic analysis assisted by NVivo (version 12; QSR International). ResultsA total of 15 young adults (age in years: median 20; mean 20.07, SD 3.17; female students: n=13, 87%; male students: n=2, 13%; all tertiary students) were interviewed in person. Participants spoke of the challenges of living during the lockdown, including social isolation, loss of motivation, and the demands of remote work or study, although some were able to find silver linings. Aroha was well liked for sounding like a “real person” and peer with its friendly local “Kiwi” communication style, rather than an authoritative adult or counselor. The chatbot was praised for including content that went beyond traditional mental health advice. Participants particularly enjoyed the modules on gratitude, being active, anger management, job seeking, and how to deal with alcohol and drugs. Aroha was described as being more accessible than traditional mental health counseling and resources. It was an appealing option for those who did not want to talk to someone in person for fear of the stigma associated with mental health. However, participants disliked the software bugs. They also wanted a more sophisticated conversational interface where they could express themselves and “vent” in free text. There were several suggestions for making Aroha more relevant to a diverse range of users, including developing content on navigating relationships and diverse chatbot avatars. ConclusionsChatbots are an acceptable format for scaling up the delivery of public mental health and well-being–enhancing strategies. We make the following recommendations for others interested in designing and rolling out mental health chatbots to better support young people: make the chatbot relatable to its target audience by working with them to develop an authentic and relevant communication style; consider including holistic health and lifestyle content beyond traditional “mental health” support; and focus on developing features that make users feel heard, understood, and empowered

Understanding prosperity in east London: Local meanings and ‘sticky’ measures of the good life

The UN’s Sustainable Development Goals (SDGs) have been conceived as a global roadmap for peace, dignity and prosperity on a healthy planet (UNDP 2016). The SDGs challenge the dominant notion of prosperity as material wealth measured by GDP and rising household incomes; instead prosperity is reframed as a shared condition to be weighed alongside ending poverty, tackling inequalities and safeguarding the environment. Cities are identified as having a critical role in generating and equitably distributing prosperity on these terms. Reframing prosperity in this way opens up space for new forms of dialogue about what it means for people everywhere to prosper, asking how material wealth and other forms of value, equity and fairness, and the needs of humans and non-humans are differentially understood and acted on. Yet this article argues that prosperity is under-studied and under-theorized by social scientists. A new research agenda, driven by empirical studies in diverse urban contexts, must form the basis for new theoretical insights and policy formation that will drive action on prosperity in the years to come. Presenting new empirical work from community-led research in three east London neighbourhoods, the article examines prosperity as a lived experience in comparison to policy goal; demonstrating how context-specific meanings and practices challenge the orthodox models and metrics that currently dominate policymaking. The authors demonstrate how situated and engaged research with local residents and citizen scientists provides the basis for developing new prosperity metrics that reflect issues of specific value and concern to individuals and communities in east London