Lessons Learned from Missouri Institutions of Higher Education Response to the COVID-19 Pandemic

Institutions of higher education (IHE) have worked tirelessly to mitigate the effect of SARS-Co-V2 (COVID-19) on their campuses. Shortly after COVID-19 hit Missouri, several state departments united their efforts to understand and problem-solve around the pandemic. The Missouri Department of Higher Education and Workforce Development (DHEWD) led one such effort, facilitating weekly meetings with members from Missouri’s IHE. The research team reviewed thirty-one video recordings from November 4, 2020, to June 9, 2021, and interviewed DHEWD staff. Using focused coding, the research team identified the role of DHEWD, leaders that emerged during the process, several challenges IHE faced during the pandemic, and successes and accomplishments. IHE were also challenged by how to mandate or incentivize the vaccine, and new human resources policies that emerged as a result of an increase in remote work schedules. This research highlights the importance of continued collaboration among IHE and various state departments, an intentional relationship between public health and IHE, and an increased investment in mental health services in order to prepare for the next public health emergency

Barriers and facilitators to implementing a patient-centered model of contraceptive provision in community health centers

Background The Contraceptive CHOICE Project developed a patient-centered model for contraceptive provision including: (1) structured, evidence-based counseling; (2) staff and health care provider education; and (3) removal of barriers such as cost and multiple appointments to initiate contraception. In preparation for conducting a research study of the CHOICE model in three community health settings, we sought to identify potential barriers and facilitators to implementation. Methods Using a semi-structured interview guide guided by a framework of implementation research, we conducted 31 qualitative interviews with female patients, staff, and health care providers assessing attitudes, beliefs, and barriers to receiving contraception. We also asked about current contraceptive provision and explored organizational practices relevant to implementing the CHOICE model. We used a grounded theory approach to identify major themes. Results Many participants felt that current contraceptive provision could be improved by the CHOICE model. Potential facilitators included agreement about the necessity for improved contraceptive knowledge among patients and staff; importance of patient-centered contraceptive counseling; and benefits to same-day insertion of long-acting reversible contraception (LARC). Potential barriers included misconceptions about contraception held by staff and providers; resistance to new practices; costs associated with LARC; and scheduling challenges required for same-day insertion of LARC. Conclusions In addition to staff and provider training, implementing a patient-centered model of contraceptive provision needs to be supplemented by strategies to manage patient and system-level barriers. Community health center staff, providers, and patients support patient-centered contraceptive counseling to improve contraception provision if organizations can address these barriers

A participatory regional partnership approach to promote nutrition and physical activity through environmental and policy change in rural Missouri

BACKGROUND: Rural residents are less likely than urban and suburban residents to meet recommendations for nutrition and physical activity. Interventions at the environmental and policy level create environments that support healthy eating and physical activity. COMMUNITY CONTEXT: Healthier Missouri Communities (Healthier MO) is a community-based research project conducted by the Prevention Research Center in St. Louis with community partners from 12 counties in rural southeast Missouri. We created a regional partnership to leverage resources and enhance environmental and policy interventions to improve nutrition and physical activity in rural southeast Missouri. METHODS: Partners were engaged in a participatory action planning process that included prioritizing, implementing, and evaluating promising evidence-based interventions to promote nutrition and physical activity. Group interviews were conducted with Healthier MO community partners post intervention to evaluate resource sharing and sustainability efforts of the regional partnership. OUTCOME: Community partners identified the benefits and challenges of resource sharing within the regional partnership as well as the opportunities and threats to long-term partnership sustainability. The partners noted that the regional participatory process was difficult, but the benefits outweighed the challenges. INTERPRETATION: Regional rural partnerships may be an effective way to leverage relationships to increase the capacity of rural communities to implement environmental and policy interventions to promote nutrition and physical activity

Association between community garden participation and fruit and vegetable consumption in rural Missouri

BACKGROUND: Fruit and vegetable consumption reduces chronic disease risk, yet the majority of Americans consume fewer than recommended. Inadequate access to fruits and vegetables is increasingly recognized as a significant contributor to low consumption of healthy foods. Emerging evidence shows the effectiveness of community gardens in increasing access to, and consumption of, fruits and vegetables. METHODS: Two complementary studies explored the association of community garden participation and fruit and vegetable consumption in rural communities in Missouri. The first was with a convenience sample of participants in a rural community garden intervention who completed self-administered surveys. The second was a population-based survey conducted with a random sample of 1,000 residents in the intervention catchment area. RESULTS: Participation in a community garden was associated with higher fruit and vegetable consumption. The first study found that individuals who worked in a community garden at least once a week were more likely to report eating fruits and vegetables because of their community garden work (X(2) (125) = 7.78, p = .0088). Population-based survey results show that 5% of rural residents reported participating in a community garden. Those who reported community garden participation were more likely to report eating fruits 2 or more times per day and vegetables 3 or more times per day than those who did not report community garden participation, even after adjusting for covariates (Odds Ratio [OR] = 2.76, 95% Confidence Interval [CI] = 1.35 to 5.65). CONCLUSION: These complementary studies provide evidence that community gardens are a promising strategy for promoting fruit and vegetable consumption in rural communities

Democratic Deliberation in the Modern World: The Systemic Turn

ABSTRACT: The normative ideals and feasibility of deliberative democracy have come under attack from several directions, as exemplified by a recent book version of a special issue of this journal. Critics have pointed out that the complexity of the modern world, voter ignorance, partisanship, apathy, and the esoteric nature of political communications make it unlikely that deliberation will be successful at creating good outcomes, and that it may in fact be counterproductive since it can polarize opinions. However, these criticisms were aimed at “micro” theories of deliberative democracy. The new “systemic” turn in deliberative democracy avoids these problems by positing a system-wide division of labor in a nation-state: experts and ordinary citizens “check” each other's opinions; partisanship and even ignorance can spur deliberation among citizens; and citizens may remain apathetic about some issues but deliberate about others. So long as the overall level of systemic deliberation increases, instead of decreases, the ideal of deliberation is still relevant in a society as complex as ours