Native American Weight Loss Movement: Pilot Test of a Culturally Tailored Weight Loss Program for American Indians

American Indians (AIs) have higher rates of obesity than other racial/ethnic groups, placing them at heightened risk for cardiovascular diseases, diabetes, and certain cancers. Culturally appropriate weight loss interventions may be the key to reducing risk. The most successful program used in AI communities has been the Diabetes Prevention Program (DPP), which limits enrollment to individuals with a clinical diagnosis of pre-diabetes. The purpose of this pilot project was to modify and culturally tailor a weight loss intervention to AI communities in Kansas to improve weight loss related behaviors among those who do not qualify for the DPP. The Native American Weight Loss Movement (NAWLM) was developed from 2012-2014 using an iterative process with 4 sequential modifications to the program. Group 1 received a slightly modified version of the DPP that was originally tailored to African Americans. Each group received an improved program based on modifications from the previous group. Our analysis shows 36.1% (95% CI: 25.7, 47.5) of all participants (n=72) lost weight; a majority (63.9%, 95% CI: 52.8-75.0) maintained weight, gained weight, or dropped out. Among individuals who completed the program (n=34), 76.5% lost weight (95% CI: 61.4, 91.5). These individuals lost an average of 2.98% body weight (95% CI: 1.58, 4.37), with 6 participants losing \u3e7% body weight. While most participants who completed the program lost weight, more research is needed to determine factors that discourage drop-out and promote behavioral changes. NAWLM shows promise as a weight loss program for AIs who do not qualify for the DPP

Refugee and migrants' involvement in participatory spaces in a US practice‐based research network study: Responding to unanticipated priorities

Abstract Background Refugees and migrants face suboptimal involvement in spaces for primary healthcare decision‐making. Given the rising numbers of resettled refugees and migrants in primary care settings in the United States, there is an urgent need for patient‐centred outcome research in practice‐based research networks (PBRNs) with diverse ethnolinguistic communities. This study explored whether researchers, clinicians and patients would achieve consensus on (1) a common set of clinical problems that were applicable across a PBRN and (2) potential clinical interventions to address those problems to inform a patient‐centred outcomes research (PCOR) study in a similar research network. Methods In this qualitative participatory health research study, patients from diverse ethnolinguistic communities and clinicians from seven practices in a US PBRN discussed preferences for PCOR responsive to patients and the clinicians who serve them in language‐discordant settings. Researchers and an advisory panel that included patients and clinicians from each participating practice held regular advisory meetings to monitor progress on project milestones and solve emerging problems. Participants took part in 10 sessions using Participatory Learning in Action and the World Café methods to identify and prioritise their ideas, using questions set for them by the advisory panel. Data were analysed based on principles of qualitative thematic content analysis. Results Participants identified common barriers in language‐discordant healthcare settings, principally patient‐clinician communication barriers and suggestions to overcome these barriers. A key finding was an unanticipated consensus about the need for attention to healthcare processes rather than a clinical research priority. Negotiation with research funders enabled further analysis of potential interventions for care processes to improve communication and shared decision‐making in consultations and the practice as a whole. Conclusion PCOR studies should examine interventions for improving communication between patients from diverse ethnolinguistic communities and primary care staff if the sorts of harms experienced by patients experiencing language‐discordant healthcare are to be reduced or prevented. Flexibility and responsiveness from funders to unanticipated findings are key structural supports for participatory health research in primary care clinical settings with this population and others who experience marginalisation and exclusion. Patient or Public Contribution Patients and clinicians participated in the study both in the formulation of the study question, data collection, analysis and dissemination of these results; consented to their individual participation; and reviewed early drafts of the manuscript

The right space at the right time: The relationship between children’s physical activity and land use/land cover

AbstractResearch increasingly suggests that moderate to vigorous physical activity (MVPA) is essential to children's health. However, little is known about the extent to which and when different urban environments influence the extent to which children engage in MVPA. To this end, this study explores the relationship between children's MVPA and urban land use and land cover (LULC) for several temporal subdivisions of children's weekly routines (before school, after school and weekends). In particular, the location and corresponding level of physical activity of 4th grade students (n=134) was recorded using paired global positioning system (GPS) receivers and accelerometers over 33days for each student. GPS locations were temporally related to accelerometry records and then geographically related to 13 categories of LULC. Mixed linear models were fitted to evaluate the extent to which duration spent in each LULC category can explain individuals' time in MVPA before school, after school, and during the weekends. Geographic cluster analysis was also applied to assess whether any significant spatial relationships between observations of MVPA may exist. Duration of exposure to vegetated parks/open spaces, built residential, and built institutional LULC was found to significantly increase children's time spent in MVPA. Further, most observations of MVPA were found to exhibit significant geographic clustering and were predominately associated with built residential areas (particularly those near schools), indicating the importance of neighborhoods and areas in close proximity to children's households on their level of physical activity

Participatory methods for research prioritization in primary care: an analysis of the World Cafe approach in Ireland and the USA

Background. There are increasing imperatives for patients and members of the public to engage as partners in identifying health research priorities. The use of participatory methods to engage stakeholders in health care in research prioritization is not commonly reported. Objective. This article analyses the use of World Cafés as a participatory method for research prioritization with marginalized communities in Ireland and the USA. Methods. The principles of purposeful and snowball sampling were followed in both settings and a diverse range of community and health care stakeholders participated (n = 63 Ireland and n = 55 USA). The principles for a classic World Café were employed but there were novel features in each setting as well. Stewart et al.’s (Patients’ and clinicians’ research priorities. Health Expect 2011; 14: 439–48, conceptual framework for patient engagement was adapted and used to comparatively analyse the strengths and weaknesses of the World Cafés, focusing on agenda setting, engagement with research processes, interactional features and outputs. Results. Design principles for World Cafés were found to align with high-quality patient engagement for research prioritization in both settings. They served to facilitate meaningful collaboration among stakeholder groups in research prioritization (research agenda setting) and explored research priorities (engagement with research). The café ambience, emphasis on hospitality and self-facilitation created an environment for dialogues within and across participating groups (interactional features). There was a commitment to follow-up actions with reference to possible subsequent research (outputs). Conclusions. The World Café is a valuable, participatory, flexible method that can be used with community and health care stakeholders for research prioritization with marginalized communities

Ethnicity recording in health and social care data collections in Ireland: where and how is it measured and what is it used for?

Background: In the European Union (EU), discrimination based on racial and ethnic origin is prohibited under the Racial Equality Directive. Ireland is one of only three EU countries where a legal duty of equality data collection is placed on public bodies. It provides an important context in which to study ethnic equality monitoring; however no systematic mapping of where it occurs in health information systems has been carried out. The aim of this study is to identify all existing national health and social care data collections with information on ethnicity and to explore how this data has been collected and used. Methods: An electronic search of a national catalogue of health and social care data collections (N = 97) was carried out to identify any collections which contained information on ethnicity. Data dictionaries were searched and key informants contacted. For each of the data collections that collected information on ethnicity, data was extracted on the ethnic categories used and how this data is collected; the completeness of ethnicity recording; and other measures related to ethnicity in the data collection. Relevant outputs for these data collections, related to ethnicity, were identified through key informants and electronic searches. Results: Of the 97 data collections, 14 (14%) collected information on ethnic or cultural background. Country of birth was collected by 10 of these 14 data collections. Most used the ethnic categories in the Census and recommended that ethnicity should be self-identified and not assigned. Reported rates of identification were generally high (≥90%). Data collections which recorded ethnicity tended to be focused on potentially high-risk populations with no routine recording in primary care. There were some examples of where ethnic equality monitoring had informed targeted interventions e.g. vaccination awareness initiatives or cultural training for healthcare staff. Conclusions: Despite strong policy and legal imperatives, there is limited data collection of ethnicity in health and social care data collections in Ireland. While there are some examples of where differences by ethnicity have been identified and acted upon, a more coordinated and comprehensive approach to the collection, quality and utilization of ethnicity data is needed to promote health equity

The impact of economic recession on the health of migrant fathers over time: results from the Growing up in Ireland longitudinal study

Background: The relationship between economic conditions and health can depend on both the health outcome measured and the composition of the population. Analysis of outcomes by both ethnicity and country of birth has been recommended. The aim of our study is to explore the impact of recession on self-rated health and depression of migrant fathers in Ireland over time, considering both ethnicity and country of birth. Methods: Longitudinal data from waves of a population-representative cohort study (Growing up in Ireland, 2008– 2013) was used with Wave 1 collected before the recession and Wave 2 collecting information on how the recession afected families. Socio-demographic variables, self-rated health and depression were compared across three groups of fathers classifed by self-identifed ethnicity and country of birth: White Irish (n=5628), Other White European (EU 10) (n=431), and Black African (n=192) using chi-square tests and logistic regression models. Rates of follow-up were compared across groups at Wave 3. Results: Prior to the recession, the rate of employment was lowest for African fathers (51% vs 81% for EU-10 fathers and 92% for Irish fathers, p<0.001). At Wave 2, African families were more likely to have experienced a very signifcant efect of the recession (40.1% compared to 22.4% for families from EU-10 and 21.3% for Irish families, p<0.001). How ever, the impact of the recession on depression and self-rated health was only found in Irish fathers. By Wave 3, rates of follow-up were lower for migrant fathers, particularly for EU-10 fathers. Conclusions: Understanding the relationship between economic conditions and health is complex and may be related to multiple dimensions of socio-economic advantage and disadvantage. African families were already more likely to be disadvantaged prior to the recession and that pattern persisted during the recession. Further research on attrition rates of migrants in population cohort studies is needed and the development of efective strategies for recruitment, follow-up and analysis