Organizational readiness for wellness promotion - a survey of 100 African American church leaders in South Los Angeles.

BackgroundChurches are an important asset and a trusted resource in the African American community. We needed a better understanding of their readiness to engage in health promotion before launching a large-scale health promotion effort in partnership with South Los Angeles churches.MethodsIn 2017, we conducted surveys with leaders of 100 churches. Surveys were conducted face-to-face (32%) or by telephone (68%) with senior pastors (one per church) and lasted on average 48 min. We compared small (less than 50 active members), medium (50-99 active members) and large churches (at least 100 active members), and assessed which church characteristics were associated with the implementation of wellness activities.ResultsMedium and large churches conducted significantly more wellness activities than small churches and were more likely to have wellness champions and health policies. Regardless of church size, insufficient budget was the most commonly cited barrier to implement wellness activities (85%). A substantial proportion of churches was not sure how to implement wellness activities (61%) and lacked volunteers (58%). Forty-five percent of the variation in the number of wellness activities in the last 12 months was explained by church characteristics, such as size of congregation, number of paid staff, leadership engagement, having a wellness ministry and barriers.ConclusionsMany churches in South Los Angeles are actively engaged in health promotion activities, despite a general lack of resources. We recommend a comprehensive assessment of church characteristics in intervention studies to enable the use of strategies (e.g., stratification by size) that reduce imbalances that could mask or magnify study outcomes. Our data provide empirical support for the inner settings construct of the Consolidated Framework for Implementation Research in the context of health promotion in African American churches

Student-Institution Fit Adopting a Faith-Based University Case Study

The research reported in this thesis took place at a time of unprecedented challenge and financial uncertainty for universities. Challenges came following the introduction of tuition fees (1998), Brexit, Covid-19 and declining birth rates. Such issues have resulted in the establishment of an increased competitive market that has seen institutions utilise incentives and unconditional offers to students to ensure recruitment targets are met. Against this background, this PhD research concerns student belonging and fit with an emphasis on cultural capital, and the congruency of students’ personal values and those of the institution. The enquiry asks whether students considered ‘fitting in’ when applying to university and ascertained if institutional values matched their own, and so explores areas that have hereunto been under-researched. Unsurprisingly, extant research indicates that students who fit with their university are more satisfied, and conversely, those who do not are more likely to misfit resulting in unhappiness, stress and withdrawal. The PhD had three phases, and incorporated longitudinal and mixed methods approaches. Phase One scrutinised the findings of the UKES survey between 2018 and 2019, which asked students why they chose to attend St Mary’s University, a faith-based institution. In Phase Two, 22 students and alumni were interviewed to explore the rationale for student choice; thematic analysis was used to establish St Mary’s unique differentiators. Phase Three explored photography within the undergraduate prospectus to establish whether it was representative of students’ experiences and how the brand or St Mary’s Way was communicated. Drawing on models proposed by Gilbreath, Kim and Nichols (2011), Schwartz, Cieciuch, Vecchione, Davidov, Fischer, Beierlein, Ramos, Verkasalo, Lönnqvist, Demirutku, Dirilen-Gumus and Konty (2012) and generic HR theory, the research culminated in the creation of a Holistic Student Fit Model which highlights the importance of congruent personal and institutional values. Of the many recommendations drawn from the findings, institutions are encouraged to ensure their social environments accommodate the increasingly diverse student population and their expectations. Universities are urged to re-evaluate how they communicate their culture to non-traditional students, allowing these learners to decide whether the institution has similar values to their own. Various examples of how the Model might be used to good effect in these matters are presented. It is also recommended that faith-based institutions articulate to students what a faith-based university is and how they differ from secular universities. Faith-based universities tend to market themselves based on their principles but do not explain how these principles translate into the everyday student experience. Examples of appreciation, mistrust and misinterpretation of St Mary’s Catholic ethos, as experienced by students, are presented. Taken together, this research has created new theory in the field of student-fit and presents new realms of future practice for those in student recruitment and retention

Scholarship, teaching practice and educational responsibility: Issues in designing and implementing a quality improvement and evidence-based practice module in the undergraduate curriculum

As part of a review of the undergraduate medical curriculum at King's College London, a module preparing students to undertake a quality improvement project (QIP) was developed. Using an illuminative evaluation method, the successes and challenges of the module were identified. The student experience lay along a continuum. At one end, QIPs enabled some significant improvements within trusts and primary care. Projects were presented in their clinical settings and at national and international conferences, and were published. At the other end of the continuum, students struggled to find an actionable project or have early and regular communication with their supervisors. Poor implementation of the module created challenges. These included misunderstanding of module requirements by students and supervisors, lack of clarity about what a feasible undergraduate project comprised and logistical problems when students moved from their QIP site to their next rotation. Travel back to the QIP site to complete projects involved missing scheduled teaching in their current rotation. Supervisors were unsure how to assess group projects. Key successes included students feeling better prepared to undertake QIPs, students developing a better understanding of the dynamics of clinical settings and teams, and how to manage these to progress projects

Exercise and Chronic Pain

Chronic pain is perhaps the most pervasive medical issue in the United States. The long-term impacts of chronic pain often cause individuals to reduce or eliminate physical activity. Chronic pain can impact physical, mental, and emotional well-being, which can limit daily activity and quality of life. The purpose of this fact sheet is to address the common barriers to being physically active with chronic pain and provide suggestions for safe ways to be physically active even when chronic pain is present

Community-Based Diabetes Screening and Risk Assessment in Rural West Virginia

This project utilized a cross-sectional study design to assess diabetes risk among 540 individuals from 12 counties using trained extension agents and community organizations in West Virginia. Individuals were screened for diabetes using (1) the validated 7-item diabetes risk assessment survey and (2) hemoglobin A1c tests. Demographic and lifestyle behaviors were also collected. The average age, body mass index, and A1c were 51.2±16.4, 31.1±7.5, and 5.8±0.74, respectively. The majority were females, Non-Hispanic Whites with no prior diagnosis of diabetes. Screenings showed that 61.8% of participants were at high risk for diabetes. Family history of diabetes (siblings or parents), overweight or obese status, sedentary lifestyle, and older age were commonly prevalent risk factors. Higher risk scores computed from the 7-item questions correlated positively with higher A1c (r=0.221, P<0.001). In multivariate logistic regression analyses, higher diabetes risk was predicted by obesity, older age, family history of hypertension, and gestational diabetes. Females were 4 times at higher risk than males. The findings indicated that community-based screenings were an effective way to assess diabetes risk in rural West Virginia. Linking diabetes screenings with referrals to lifestyle programs for high risk individuals can help reduce the burden of diabetes in the state

What are the implications for patient safety and experience of a major healthcare IT breakdown? A qualitative study

Introduction: To explore the impact of a three-week downtime to an electronic pathology system on patient safety and experience. Methods: Qualitative study consisting of semi-structured interviews and a focus group at a large NHS teaching hospital in England. Participants included NHS staff (n=16) who represented a variety of staff groups (doctors, nurses, healthcare assistants) and board members. Data were collected 2-5 months after the outage and were analysed thematically. Results: We present the implications which the IT breakdown had for both patient safety and patient experience. Whilst there was no actual recorded harm to patients during the crisis, there was strong and divided opinion regarding the potential for a major safety incident to have occurred. Formal guidance existed to assist staff to navigate the outage but there was predominantly a reliance on informal workarounds. Junior clinicians seemed to struggle without access to routine blood test results whilst senior clinicians seemed largely unperturbed. Patient experience was negatively affected due to the extensive wait time for manually processed diagnostic tests, increasing logistical problems for patients. Conclusion: The potential negative consequences on patient safety and experience relating to IT failures cannot be underestimated. To minimise risks during times of crisis, clear communication involving all relevant stakeholders, and guidance and management strategies that are agreed upon and communicated to all staff are recommended. To improve patient experience flexible approaches to patient management are suggested. Key words: Patient safety, patient experience, quality, qualitative, secondary care, NHS, crisis, technolog