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

Modus Vivendi Beyond the Social Contract: Peace, Justice, and Survival in Realist Political Theory

This essay examines the promise of the notion of modus vivendi for realist political theory. I interpret recent theories of modus vivendi as affirming the priority of peace over justice, and explore several ways of making sense of this idea. I proceed to identify two key problems for modus vivendi theory, so conceived. Normatively speaking, it remains unclear how this approach can sustain a realist critique of Rawlsian theorizing about justice while avoiding a Hobbesian endorsement of absolutism. And conceptually, the theory remains wedded to a key feature of social contract theory: political order is conceived as based on agreement. This construes the horizontal tensions among individual or group agents in society as prior to the vertical, authoritative relations between authorities and their subjects. Political authority thereby appears from the start as a solution to societal conflict, rather than a problem in itself. I argue that this way of framing the issue abstracts from political experience. Instead I attempt to rethink the notion of modus vivendi from within the lived experience of political conflict, as oriented not primarily toward peace, but political survival. With this shift of perspective, the idea of modus vivendi shows us, pace Bernard Williams, that the “first political question” is not how to achieve order and stability, but rather: what can I live with

Building Bridges with Boats: Preserving Community History through Intra- and Inter-Institutional Collaboration

This chapter discusses Launching through the Surf: The Dory Fleet of Pacific City, a project which documents the historical and contemporary role of dory fishers in the life of the coastal village of Pacific City, Oregon, U.S. Linfield College’s Department of Theatre and Communication Arts, its Jereld R. Nicholson Library, the Pacific City Arts Association, the Pacific City Dorymen\u27s Association, and the Linfield Center for the Northwest joined forces to engage in a collaborative college and community venture to preserve this important facet of Oregon’s history. Using ethnography as a theoretical grounding and oral history as a method, the project utilized artifacts from the dory fleet to augment interview data, and faculty/student teams created a searchable digital archive available via open access. The chapter draws on the authors’ experiences to identify a philosophy of strategic collaboration. Topics include project development and management, assessment, and the role of serendipity. In an era of value-added services where libraries need to continue to prove their worth, partnering with internal and external entities to create content is one way for academic libraries to remain relevant to agencies that do not have direct connections to higher education. This project not only developed a positive “town and gown” relationship with a regional community, it also benefited partner organizations as they sought to fulfill their missions. The project also serves as a potential model for intra- and inter-agency collaboration for all types of libraries

A multidimensional account of democratic legitimacy: how to make robust decisions in a non-idealized deliberative context

This paper analyses the possibility of granting legitimacy to democratic decisionmaking procedures in a context of deep pluralism. We defend a multidimensional account according to which a legitimate system needs to grant, on the one hand, that citizens should be included on an equal footing and acknowledged as reflexive political agents rather than mere beneficiaries of policies, and, on the other hand, that their decisions have an epistemic quality. While Estlund\u2019s account of imperfect epistemic proceduralism might seem to embody a dualistic conception of democratic legitimacy, we point out that it is not able to recognize citizens as reflexive political agents and is grounded in an idealized model of the circumstances of deliberation. To overcome these ambiguities, we develop an account of democratic legitimacy according to which disagreement is the proper expression of citizens\u2019 reflexive agency and the attribution of epistemic authority does not stem from a major expertise or specific ability, but it comes through the public confrontation among disagreeing agents. Consequently, the epistemic value of deliberation should be derived from the reasons-giving process rather than from the reference to the alleged quality of its outcomes. In this way, we demonstrate the validity of the multidimensional perspective of legitimacy, yet abstain from introducing any outcome-oriented criterion. Finally, we argue that this account of legitimacy is well suited for modeling deliberative democracy as a decision-making procedure that respects the agency of every citizen and grants her opportunity to influence public choices

"Actual" does not imply "feasible"

The familiar complaint that some ambitious proposal is infeasible naturally invites the following response: Once upon a time, the abolition of slavery and the enfranchisement of women seemed infeasible, yet these things were actually achieved. Presumably, then, many of those things that seem infeasible in our own time may well be achieved too and, thus, turn out to have been perfectly feasible after all. The Appeal to History, as we call it, is a bad argument. It is not true that if some desirable state of affairs was actually achieved, then it was feasible that it was achieved. “Actual” does not imply “feasible,” as we put it. Here is our objection. “Feasible” implies “not counterfactually fluky.” But “actual” does not imply “not counterfactually fluky.” So, “actual” does not imply “feasible.” While something like the Flukiness Objection is sometimes hinted at in the context of the related literature on abilities, it has not been developed in any detail, and both premises are inadequately motivated. We offer a novel articulation of the Flukiness Objection that is both more precise and better motivated. Our conclusions have important implications, not only for the admissible use of history in normative argument, but also by potentially circumscribing the normative claims that are applicable to us

Regulating the employment dynamics of domestic supply chains

This paper sheds light on the role that the regulation of primarily domestic, rather than global, supply chains could play in protecting and enhancing standards of workplace health and safety, as well as employment standards more generally. The analysis presented confirms the potential relevance of such regulation in these regards. However, it also reinforces existing evidence pointing to the fact that only very rarely will market-related considerations on their own prompt purchasers to seek to directly influence the employment practices of their suppliers. The paper ends therefore by highlighting a number of key issues relating to the design of regulatory initiatives aimed at protecting and enhancing employment conditions within supply chains