A Systematic Review of Health-Related Outcomes from Community Health Worker Interventions in Health Promotion, Disease Prevention and Chronic Disease Management

Community health workers (CHWs) can serve as a bridge to the health care system for both disease prevention and management. We aimed to conduct a systematic review of the effectiveness of CHW interventions in the areas of health promotion, disease prevention and chronic disease management. Methods: We searched Medline, the Cochrane Database, and CINAHL from their inception through October 2008 using 12 different terms for CHWs including the MESH term community health aides. We included studies with a comparison group that were conducted in the United States, published in English, and included at least 40 participants. Two reviewers independently assessed each abstract and full text articles for inclusion. Disagreements were resolved by consensus. Data was extracted onto a standard form by one reviewer and checked for completeness and accuracy by a second reviewer. Trained reviewers abstracted data and assessed the methodologic quality (internal validity) of studies using predefined criteria based on the U.S. Preventive Services Task Force and the National Health Service Centre for Reviews and Dissemination (U.K.) criteria. Results: Our initial search identified 992 articles. Of these, 24 studies met the inclusion criteria and addressed disease prevention or management. Identified studies were diverse in terms of target population, intervention design, and condition of interest. All of the studies focused on low income or minority populations. Trial duration ranged from 3 months to 4 years. Nineteen studies were randomized controlled trials and 5 were observational. Of the 24 studies, 2 were rated good quality, 14 fair, and 8 poor. Heterogeneity of study designs, conditions of interest and outcomes precluded quantitative synthesis of the results. Eleven studies addressed disease prevention, including pediatric immunizations (3), cardiovascular disease (2), diabetes prevention (1), HIV prevention (1), second-hand smoke exposure (1), colorectal cancer prevention (1), and general preventive care (2). Eight of eleven studies found that CHW interventions were more effective than usual care in either changing knowledge (2 of 2), behavior (4 of 6), health outcomes (2 of 4) or health care utilization (2 of 2). Thirteen studies addressed disease management, including diabetes mellitus (4), hypertension (4), asthma (2), back pain (1), tuberculosis (1), and mental health (1). In diabetes management, two of four studies found that a CHW intervention was more effective than usual care in decreasing HgbAlc. Studies addressing hypertension management (4) did not show a significant difference in blood pressure control between groups, although participants in the CHW groups improved when compared to baseline values. Both asthma studies demonstrated that CHW interventions were effective in reducing unscheduled health care services, but no more effective than comparisons for improving symptoms. Conclusions: CHWs have been used in many different health conditions, largely targeting low income and minority populations. CHW interventions in the area of disease prevention show promising benefits in improving patient knowledge and health care utilization, when compared to usual care. For chronic disease management, the majority of CHW interventions failed to show greater improvement in health outcomes than usual care except in asthma.Master of Public Healt

Using Positive Deviance for Determining Successful Weight- Control Practices

Based on positive deviance (examining the practices of successful individuals), we identified five primary themes from 36 strategies that help to maintain long-term weight loss (weight control) in 61 people. We conducted in-depth interviews to determine what successful individuals did and/or thought about regularly to control their weight. The themes included weight-control practices related to (a) nutrition: increase water, fruit, and vegetable intake, and consistent meal timing and content; (b) physical activity: follow and track an exercise routine at least 3×/week; (c) restraint: practice restraint by limiting and/or avoiding unhealthy foods; (d) self-monitor: plan meals, and track calories/weight progress; and (e) motivation: participate in motivational programs and cognitive processes that affect weight-control behavior. Using the extensive data involving both the practices and practice implementation, we used positive deviance to create a comprehensive list of practices to develop interventions for individuals to control their weight

Working to Increase Stability through Exercise (WISE): screening, recruitment, and baseline characteristics

Background The aim of this paper is to describe the utility of various recruitment modalities utilized in the Working to Increase Stability through Exercise (WISE) study. WISE is a pragmatic randomized trial that is testing the impact of a 3-year, multicomponent (strength, balance, aerobic) physical activity program led by trained volunteers or delivered via DVD on the rate of serious fall-related injuries among adults 65 and older with a past history of fragility fractures (e.g., vertebral, fall-related). The modified goal was to recruit 1130 participants over 2 years in three regions of Pennsylvania. Methods The at-risk population was identified primarily using letters mailed to patients of three health systems and those over 65 in each region, as well as using provider alerts in the health record, proactive recruitment phone calls, radio advertisements, and presentations at community meetings. Results Over 24 months of recruitment, 209,301 recruitment letters were mailed, resulting in 6818 telephone interviews. The two most productive recruitment methods were letters (72% of randomized participants) and the research registries at the University of Pittsburgh (11%). An average of 211 letters were required to be mailed for each participant enrolled. Of those interviewed, 2854 were ineligible, 2,825 declined to enroll and 1139 were enrolled and randomized. Most participants were female (84.4%), under age 75 (64.2%), and 50% took an osteoporosis medication. Not having a prior fragility fracture was the most common reason for not being eligible (87.5%). The most common reason provided for declining enrollment was not feeling healthy enough to participate (12.6%). Conclusions The WISE study achieved its overall recruitment goal. Bulk mailing was the most productive method for recruiting community-dwelling older adults at risk of serious fall-related injury into this long-term physical activity intervention trial, and electronic registries are important sources and should be considered

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

The dual burden of malnutrition in the United States and the role of non-profit organizations

The dual burden of malnutrition (obesity or a non-communicable disease coupled with malnutrition) is prevalent in more than half of all malnourished households that reside in the US. Non-profit organizations should make a conscientious effort to not serve products high in sugar and saturated fat, and low in fiber. Instead, they should diligently serve nutrient-dense foods rich in produce, whole grains and omega 3 fatty acids to minimize health disparities prevalent in LSES households. Nonprofit organizations have the potential to decrease health disparities nationally by feeding health sustaining products such as whole grains, fresh produce and lean proteins. This commentary lists feasible options for organizations to serve healthier options and reduce health disparities such as implementing nutrition policies, capitalizing on donations and securing partnerships. Keywords: Obesity, Malnutrition, Lower socioeconomic status, Non-profit, Organizations, Youth, Diet, Nutrition, Health disparitie

Assessing the use of constructs from the consolidated framework for implementation research in U.S. rural cancer screening promotion programs: a systematic search and scoping review

Abstract Background Cancer screening is suboptimal in rural areas, and interventions are needed to improve uptake. The Consolidated Framework for Implementation Research (CFIR) is a widely-used implementation science framework to optimize planning and delivery of evidence-based interventions, which may be particularly useful for screening promotion in rural areas. We examined the discussion of CFIR-defined domains and constructs in programs to improve cancer screening in rural areas. Methods We conducted a systematic search of research databases (e.g., Medline, CINAHL) to identify studies (published through November 2022) of cancer screening promotion programs delivered in rural areas in the United States. We identified 166 records, and 15 studies were included. Next, two reviewers used a standardized abstraction tool to conduct a critical scoping review of CFIR constructs in rural cancer screening promotion programs. Results Each study reported at least some CFIR domains and constructs, but studies varied in how they were reported. Broadly, constructs from the domains of Process, Intervention, and Outer setting were commonly reported, but constructs from the domains of Inner setting and Individuals were less commonly reported. The most common constructs were planning (100% of studies reporting), followed by adaptability, cosmopolitanism, and reflecting and evaluating (86.7% for each). No studies reported tension for change, self-efficacy, or opinion leader. Conclusions Leveraging CFIR in the planning and delivery of cancer screening promotion programs in rural areas can improve program implementation. Additional studies are needed to evaluate the impact of underutilized CFIR domains, i.e., Inner setting and Individuals, on cancer screening programs