A review of programs that targeted environmental determinants of Aboriginal and Torres Strait Islander health

This review finds that there are relatively few papers describing interventions that target environmental determinants of Indigenous health.Abstract: Objective: Effective interventions to improve population and individual health require environmental change as well as strategies that target individual behaviours and clinical factors. This is the basis of implementing an ecological approach to health programs and health promotion. For Aboriginal People and Torres Strait Islanders, colonisation has made the physical and social environment particularly detrimental for health.Methods and results: We conducted a literature review to identify Aboriginal health interventions that targeted environmental determinants of health, identifying 21 different health programs. Program activities that targeted environmental determinants of health included: Caring for Country; changes to food supply and/or policy; infrastructure for physical activity; housing construction and maintenance; anti-smoking policies; increased workforce capacity; continuous quality improvement of clinical systems; petrol substitution; and income management. Targets were categorised according to Miller’s Living Systems Theory. Researchers using an Indigenous community based perspective more often identified interpersonal and community-level targets than were identified using a Western academic perspective.Conclusions: Although there are relatively few papers describing interventions that target environmental determinants of health, many of these addressed such determinants at multiple levels, consistent to some degree with an ecological approach. Interpretation of program targets sometimes differed between academic and community-based perspectives, and was limited by the type of data reported in the journal articles, highlighting the need for local Indigenous knowledge for accurate program evaluation.Implications: While an ecological approach to Indigenous health is increasingly evident in the health research literature, the design and evaluation of such programs requires a wide breadth of expertise, including local Indigenous knowledge.Authored by Leah Johnston, Joyce Doyle, Bec Morgan, Sharon Atkinson-Briggs, Bradley Firebrace, Mayatili Marika, Rachel Reilly, Margaret Cargo, Therese Riley and Kevin Rowley

The Effects of Taping versus Bracing on Postural Stability of the Ankle

External ankle supports, such as athletic tape and braces, used prophylactically and postinjury, have enabled athletes to participate, when their absence would have either limited participation or possibly allowed an injury. These supports offer an extrinsic mechanical source of support for the ankle. The ankle, however, is also dependent on the proprioception system, including visual input, to maintain balance through motor involvement of regional ankle musculature. It would appear that the addition of external support would enhance the overall integrity of the ankle; however, does that support exert an influence, positive or negative, on the proprioception system at the joint? The purpose of this study was to determine the effect external support on the proprioception system via balance assessment and to determine if that effect is different when comparing athletic tape to an ankle brace. Thirty-three healthy male and female subjects (mean age 24.3 years) participated. The Balance Master 8.2, a computerized balance assessment device, was used to test and compare the effects of bracing, taping, and control on the ankle while performing the Unilateral Stance test with eyes open and closed, and the Step/Quick Turn test. Each subject randomly selected a face-down card to determine which ankle would be tested, which test they would begin with, and the order of control, tape, and a brace. There was a statistically significant difference in the Unilateral Stance with eyes closed test. There was no statistical difference between the supported conditions; however, significance was demonstrated when unsupported and supported were compared, with increased postural sway exhibited in supported conditions. There were no other statistically significant differences among the other tests and conditions. These results support previous findings in which external suppOli coincided with increased postural sway. Our study also showed that no difference in postural sway occurred between different forms of support, whether they involved an extensive contact area such as athletic tape or reduced contact area such as a low profile brace. These findings suggest that the proprioceptive system is less involved in maintaining balance when an external ankle support is applied

Planning to be routine : habit as a mediator of the planning-behaviour relationship in healthcare professionals

Background: Gaps in the quality of care provided to people with type 2 diabetes are regularly identified. Healthcare professionals often have a strong intention to follow practice guidelines during consultations with people with type 2 diabetes; however, this intention does not always translate into action. Action planning (planning when, where and how to act) and coping planning (planning how to overcome pre-identified barriers) have been hypothesised to help with the enactment of intentions by creating mental cue-response links that promote habit formation. This study aimed to investigate whether habit helps to better understand how action and coping planning relate to clinical behaviour in the context of type 2 diabetes care. Methods: The study utilised a prospective correlational design with six nested sub-studies. General practitioners and practice nurses (n = 427 from 99 UK primary care practices) completed measures of action planning, coping planning and habit at baseline and then self-reported their enactment of guideline-recommended advising, prescribing and examining behaviours 12 months later. Bootstrapped mediation analyses were used to test the indirect effect of action and coping planning on healthcare professionals' clinical behaviour via their relationship with habit. Results: Healthcare professionals who reported higher degrees of action or coping planning for performing six guideline recommended behaviours in the context of type 2 diabetes care were more likely to report performing these behaviours in clinical practice. All 12 bootstrapped mediation analyses showed that the positive relationship between planning (action and coping planning) and healthcare professionals' clinical behaviour operated indirectly through habit. Conclusions: These findings suggest that habit mediates the relationship between planning (action and coping planning) and healthcare professional behaviour. Promoting careful action and coping planning may support routinised uptake of guideline-recommended care by healthcare professionals in the primary care setting. Given the competing demands on healthcare professionals, exploring the behavioural processes involved in promoting more routinisation of behaviours where possible and appropriate could free up cognitive capacity for clinical behaviours that rely on more deliberation.Peer reviewe

North Carolina Coalition Against Domestic Violence: North Carolina Domestic Violence Enhancement and Leadership Through Alliances (NC DELTA) Community Assessment and Evaluation Project in New Hanover County, North Carolina

Background: An estimated one in five North Carolina women report experiencing violence by an intimate partner in their lifetime, putting them at increased risk for serious negative physical, emotional, mental, and sexual health outcomes (CDC, 2011). The Centers for Disease Control and Prevention (CDC) funds the North Carolina Coalition Against Domestic Violence's (NCCADV) efforts to prevent first time perpetration of domestic violence (DV) as a part of a CDC collaborative called Domestic Violence Prevention Enhancement and Leadership Through Alliances initiative (DELTA). DELTA is a national initiative that funds 14 state domestic violence coalitions to provide support, training and technical assistance to increase the capacity of statewide systems to support the prevention of DV and increase the capacity of local practitioners to plan, implement and evaluate efforts that prevent first time perpetration of DV and promote healthy relationships. In North Carolina, efforts on the local level are concentrated within two Coordinated Community Response (CCR) teams in New Hanover County and Chatham County. Methods: In collaboration with members from EVOLVE! Wilmington, NCCADV and NC DELTA's, the 2011-2012 Capstone team supported the assessment and evaluation of local initiatives in New Hanover, NC. The Capstone team worked to achieve this goal through two distinct groups of deliverables: (1) the community assessment deliverables and (2) the process and outcome evaluation deliverables. The deliverables for the community assessment component of our work plan included: (1a) the Community Assessment Survey, (1b) a PowerPoint presentation of the community assessment findings, and (1c) a fact sheet of community assessment findings. The deliverables for the evaluation component of our work plan included: (2a) process and outcome evaluation toolkits for both the Civil Workplace Summit and Faith Leader Trainings, and (2b) a 5-hour evaluation training workshop. The tools were developed collaboratively with CCR members and designed to increase organizational capacity and increase the likelihood of institutionalization within the organization. Results: Working on the community assessment deliverables, the Capstone Team found that the current survey was too long and implementation plan presented challenges to achieving a large and diverse sample size. Changes were made to revise the survey and maximize community partner resources in the data collection process. Over 500 respondents participated in the community assessment. Key findings from the data analysis included: Respondents recognize that sexual and domestic violence are problems on the county level, but not within their workplace or among close friends; There was almost no variation between the percent of men and women who agreed with domestic and sexual violence myths; There was a large variation in percent of respondents who agreed with domestic and sexual violence myths between education levels; Younger and older age groups had the lowest bystander efficacy; Over 95% of people felt that services should be funded to both support victims and their children and to prevent domestic violence and sexual violence; Zip code 28412 had the lowest awareness of domestic and sexual violence services. Working on the evaluation deliverables, the Capstone team found that three out of the five EVOLVE! Wilmington projects did not have consistent implementation and clear logic models, and therefore did not have the capacity to begin evaluation. Additionally, current tools are long, overly complicated and cumbersome to fill out; tools should be simplified and pared down for intended users. Based on a participant evaluation of the training workshop, the Capstone team found that: Participants' confidence in creating logic models and using SurveyMonkeyTM increased; Most participants indicated that they would use the information from the training to implement changes in their organization. Discussion: The deliverables, in concert with ongoing technical assistance and support from NCCADV and NC DELTA will likely increase the capacity of local CCR staff to revise and refine DV prevention programming in New Hanover County.Master of Public Healt

Changing healthcare professionals' non-reflective processes to improve the quality of care

Rationale. Translating research evidence into clinical practice to improve care involves healthcare professionals adopting new behaviours and changing or stopping their existing behaviours. However, changing healthcare professional behaviour can be difficult, particularly when it involves changing repetitive, ingrained ways of providing care. There is an increasing focus on understanding healthcare professional behaviour in terms of non-reflective processes, such as habits and routines, in addition to the more often studied deliberative processes. Theories of habit and routine provide two complementary lenses for understanding healthcare professional behaviour, although to date, each perspective has only been applied in isolation. Objectives To combine theories of habit and routine to generate a broader understanding of healthcare professional behaviour and how it might be changed. Methods Sixteen experts met for a two-day multidisciplinary workshop on how to advance implementation science by developing greater understanding of non-reflective processes. Results From a psychological perspective ‘habit’ is understood as a process that maintains ingrained behaviour through a learned link between contextual cues and behaviours that have become associated with those cues. Theories of habit are useful for understanding the individual's role in developing and maintaining specific ways of working. Theories of routine add to this perspective by describing how clinical practices are formed, adapted, reinforced and discontinued in and through interactions with colleagues, systems and organisational procedures. We suggest a selection of theory-based strategies to advance understanding of healthcare professionals' habits and routines and how to change them. Conclusion Combining theories of habit and routines has the potential to advance implementation science by providing a fuller understanding of the range of factors, operating at multiple levels of analysis, which can impact on the behaviours of healthcare professionals, and so quality of care provision.Peer reviewe

Characterizing Symptoms and Identifying Biomarkers of Long COVID in People With and Without HIV: Protocol for a Remotely Conducted Prospective Observational Cohort Study

Background: Living with HIV is a risk factor for severe acute COVID-19, but it is unknown whether it is a risk factor for long COVID./ Objective: This study aims to characterize symptoms, sequelae, and cognition formally and prospectively 12 months following SARS-CoV-2 infection in people living with HIV compared with people without HIV. People with no history of SARS-CoV-2 infection, both with and without HIV, are enrolled as controls. The study also aims to identify blood-based biomarkers or patterns of immune dysregulation associated with long COVID./ Methods: This prospective observational cohort study enrolled participants into 1 of the following 4 study arms: people living with HIV who had SARS-CoV-2 infection for the first time <4 weeks before enrollment (HIV+COVID+ arm), people without HIV who had SARS-CoV-2 infection for the first time within 4 weeks of enrollment (HIV−COVID+ arm), people living with HIV who believed they never had SARS-CoV-2 infection (HIV+COVID− arm), and people without HIV who believed they never had SARS-CoV-2 infection (HIV−COVID− arm). At enrollment, participants in the COVID+ arms recalled their symptoms, mental health status, and quality of life in the month before having SARS-CoV-2 infection via a comprehensive survey administered by telephone or on the web. All participants completed the same comprehensive survey 1, 2, 4, 6, and 12 months after post–acute COVID-19 symptom onset or diagnosis, if asymptomatic, (COVID+ arms) or after enrollment (COVID− arms) on the web or by telephone. In total, 11 cognitive assessments were administered by telephone at 1 and 4 months after symptom onset (COVID+ arms) or after enrollment (COVID− arms). A mobile phlebotomist met the participants at a location of their choice for height and weight measurements, orthostatic vital signs, and a blood draw. Participants in the COVID+ arms donated blood 1 and 4 months after COVID-19, and participants in the COVID− arms donated blood once or none. Blood was then shipped overnight to the receiving study laboratory, processed, and stored./ Results: This project was funded in early 2021, and recruitment began in June 2021. Data analyses will be completed by summer 2023. As of February 2023, a total of 387 participants were enrolled in this study, with 345 participants having completed enrollment or baseline surveys together with at least one other completed study event. The 345 participants includes 76 (22%) HIV+COVID+, 121 (35.1%) HIV−COVID+, 78 (22.6%) HIV+COVID−, and 70 (20.3%) HIV−COVID− participants./ Conclusions: This study will provide longitudinal data to characterize COVID-19 recovery over 12 months in people living with and without HIV. Additionally, this study will determine whether biomarkers or patterns of immune dsyregulation associate with decreased cognitive function or symptoms of long COVID

Ripe to be Heard: Worker Voice in the Fair Food Programme

The Fair Food Program (FFP) provides a mechanism through which agricultural workers’ collective voice is expressed, heard and responded to within global value chains. The FFP's model of worker-driven social responsibility presents an alternative to traditional corporate social responsibility. This article identifies the FFP's key components and demonstrates its resilience by identifying the ways in which the issues faced by a new group of migrant workers – recruited through a “guest-worker” scheme – were incorporated and dealt with. This case study highlights the important potential presented by the programme to address labour abuses across transnationalized labour markets while considering early replication possibilities

Learning context effects: Study abroad, formal instruction and international immersion classrooms

This book deals with the effects of three different learning contexts mainly on adult, but also on adolescent, learners’ language acquisition. The three contexts brought together in the monograph include i) a conventional instructed second language acquisition (ISLA) environment, in which learners receive formal instruction in English as a Foreign Language (EFL); ii) a Study Abroad (SA) context, which learners experience during mobility programmes, when the target language is no longer a foreign but a second language learnt in a naturalistic context; iii) the immersion classroom, also known as an integrated content and language (ICL) setting, in which learners are taught content subjects through the medium of the target language—more often than not English, used as the Lingua Franca (ELF). The volume examines how these contexts change language learners’ linguistic performance, and also non-linguistic, that is, it throws light on how motivation, sense of identity, interculturality, international ethos, and affective factors develop. To our knowledge, no publication exists which places the three contexts on focus in this monograph along a continuum, as suggested in Pérez-Vidal (2011, 2014), with SA as ‘the most naturalistic’ context on one extreme, ISLA on the other, and ICL somewhere in between, while framing them all as international classrooms. Concerning target languages, the nine chapters included in the volume analyze English, and one chapter deals with Spanish, as the target language. As for target countries in SA programmes, data include England, Ireland, France, Germany, and Spain in Europe, but also Canada, China, and Australia. While the main bulk of the chapters deal with tertiary level language learners, a language learning population which has received less attention by research thus far, one chapter deals with adolescent learners. Carmen Pérez-Vidal, Sonia López, Jennifer Ament and Dakota Thomas-Wilhelm all served on the organizing committee for the EUROSLA workshop held at the Universitat Pompeu Fabra, Barcelona, in May 2016. It is from this workshop that this monograph was inspire