A Participatory Approach to Physical Activity Among People with Severe and Persistent Mental Illness

People with severe and persistent mental illness (SPMI) in the U.S. have rates of co-occurring chronic medical illnesses two to three times higher than the general population and a corresponding reduction in life expectancy of 25 years. People with SPMI in the community setting are a vulnerable population, subject to self- and perceived stigma that prevent them from seeking adequate medical care. A majority of early mortality among people with SPMI is related to preventable causes such as cardiovascular diseases and diabetes. Involvement in physical activity has shown to improve the mental and physical health of people with SPMI. The goal of this dissertation is to explore challenges and prospects in the development of a tailored physical activity intervention for people with SPMI and in a community setting. The data is organized into three manuscripts predicated on an established community-academic partnership that led to the development, design, implementation and evaluation of the intervention through a Community Based Participatory Research (CBPR) approach. Manuscript one is a literature review that examines what is known regarding community-based physical activity interventions and outcomes and mental and physical health outcomes among people with SPMI, identifying critical gaps in the literature. Manuscript two studies the perceived benefits and barriers to physical activity among people with SPMI in the community setting where the intervention took place to provide qualitative evidence for the intervention design. Manuscript three focuses on the community-academic partnership and the development and implementation of a feasibility study focused on the effect of physical activity on the physical and mental health outcomes among people with SPMI in this community setting. This dissertation brings an innovative approach to recovery in adjunct to pharmaceutical treatments or cognitive approaches. It provides a platform to understand what is required to carry out a community-based intervention with rigor and collaboration. The public health significance of this dissertation is presented in the findings of this research, which suggest that it is paramount to understand the needs of the population, while recognizing that tailoring a physical activity intervention based on these needs to improve the physical and mental health among this vulnerable population has challenges and opportunities for collaboration. Future research, programs, and policy should consider these findings to improve the well-being of people living with SPMI in the U.S. and globally

Midterm evaluation of USAID Tulonge Afya Project

This report examines findings from a mid-term evaluation conducted by Breakthrough RESEARCH, a USAID-funded research and evaluation project. The purpose of this evaluation is to provide recommendations to enhance the effectiveness of USAID Tulonge Afya’s strategies and activities as the program enters year three. The evaluation identified successes, promising strategies, and interventions that can be sustained throughout the life of the project and scaled-up to other regions and districts. The evaluation also helps to identify facilitating and limiting factors for implementing a complex, integrated social and behavior change communication (SBCC) program, with applications for the future of this project as well as future integrated SBCC programming globally

Gender integration in social and behavior change

This document is a review of recent social and behavior change-focused program literature focusing on the integration of gender considerations into health and non-health social and behavior change interventions. The review revealed eight promising practices: employing a gender perspective throughout the program cycle to improve outcomes; synchronizing gender strategies to ensure inclusion of men and women, boys and girls; addressing gendered health disparities that affect service use; reducing harmful traditional practices; ensuring community involvement and accountability for promotion of gender equality; considering gender during emergency preparedness and response; accounting for intersecting gendered vulnerabilities that influence health and development outcomes; and building organizational capacities and systems for gender integration through a continuous learning approach. These gender integration practices were found to be operationalized at different levels of the Socio-Ecological Model for Change and were mutually reinforcing. When employed, these practices can strengthen gender integration and mainstreaming efforts within social and behavior change programming

Lessons learned for social and behavior change programming from the USAID Zika response

Breakthrough RESEARCH documented the strengths, weaknesses, gaps, and challenges in social and behavior change (SBC) efforts to combat the Zika outbreak to inform future public health emergency programming. What were the successes, challenges, and gaps in designing, implementing, and adapting SBC programming in the USAID Zika response? What were the successes, challenges, and gaps in generating and using data and evidence in SBC programming in the USAID Zika response? What do the successes, challenges, and gaps of the USAID Zika response’s SBC programming imply for future health emergency responses? Eight recommendations are offered as a reslt of these research queries

The Beyond Bias Project: Building evidence to inform practice for provider behavior change programming

Breakthrough RESEARCH, with input from the United States Agency for International Development (USAID) and cross-sectoral implementing partners, developed research and learning agendas (RLAs) to strengthen two important areas of social and behavior change (SBC) programming: integrated SBC programming and provider behavior change (PBC). In this Research Spotlight From Breakthrough RESEARCH, we share key highlights from a PBC project, Beyond Bias, to: 1) Demonstrate how priority RLA questions are being answered to improve PBC programming; 2) Share tools and resources for other program implementation and research partners; and 3) Raise the visibility of current PBC technical work

Six recommendations for provider behavior change in family planning

Health care provider behavior has the power to influence family planning and reproductive health outcomes positively and negatively, underlining the importance of provider behavior change (PBC) initiatives. However, global health practitioners lack a shared understanding of PBC interventions and what influences provider behavior. Furthermore, PBC interventions in family planning and reproductive health have tended to address individual and workplace environmental factors rather than the full breadth of factors that influence provider behavior, including the broader systems and contexts where providers operate. This commentary contributes to a common understanding of PBC, including the determinants of provider behavior, and describes actions to advance PBC efforts in family planning and reproductive health. To inform these considerations, we conducted a narrative review of more than 70 articles and project materials describing interventions that aimed to change provider behaviors pertaining to family planning and reproductive health and used the review to identify the most and least common provider cadres addressed, behavioral determinants targeted, and strategies implemented. We strongly encourage global health practitioners to design future PBC interventions for a more diverse set of cadres and contexts, consider the full set of factors that influence provider behavior, pair provider- and client-side interventions, shift the narrative around PBC from “blaming” to supporting providers, move beyond training-only interventions, and improve the rigor of measurement and evidence-building efforts for PBC. These considerations can be used to advance the field of PBC in family planning and reproductive health to improve outcomes across the service delivery continuum