Community-based health interventions

Introduction: Substance dependence is one of the most important factors affecting the quality of life of substance-dependent patients all over the world.  The purpose of the present study was to investigate the effect of hope therapy on the general health of substance-dependent patients undergoing methadone maintenance treatment in Semnan city, Semnan province, Iran.
Method: the present study was a Quasi-experimental research design using pre-test, post-test and follow along with the control group. Community to study drug-dependent patients in methadone maintenance treatment in the Semnan city. The subjects consisted of 40 cases of drug-dependent patients in methadone maintenance treatment in Semnan who were to leave drug-dependency. The patients were divided randomly into two groups and planning. In addition to drug treatment, methadone maintenance treatment group was treated by hope. Hope Therapy was conducted in 8 sessions on the experimental group and the control group in this period was on the waiting list for psychological intervention. All patients participating in the intervention than the demographic questionnaire and general health questionnaire (SF36) there. After the end of treatment and three months after intervention, subjects were re-evaluated by the questionnaires.
Results: Analysis of variance showed that the mean scores general health in the experimental group showed a significant change in the post-test and effects of treatment were permanent after three months of treatment.
Conclusions: According to the results it can be concluded that Hope therapy is effective on general health, drug-dependent patients in methadone maintenance treatment.

A study of the experiences of Roma families in the UK in contact with social services Child Protection services. These qualitative findings have uniquely been triangulated against a review of publicly accessible reports of court cases and 'serious case reviews' where Roma families are the subject of such cases; and supplemented by interviews with lawyers, support organisations and Social Workers working with the communities

This paper uses findings from two separate cases from different extended disaster situations: Hurricane Katrina's long-term healthcare impact and Community Health Workers' use to access minority communities in Milwaukee, Wisconsin, at the height of COVID-19. We explore the use of sesnsorized health interventions to both increase positive health outcomes for at-risk communities, but also how these practices can subjugate the very people they intend to help. We explore these cases through the lenses of data doubles and surveillant assemblage. Acts of noncompliance to medical data collection standards and recommended medical interventions against one's bodily subtle form of dehumanization, a justification for further intervention, and a form of institutional control. We show how this plays out in diverse ways in extended disaster contexts.

The article is an attempt to collect and describe non-medical aspects of the HIV epidemic in Poland in 2023, aspects that often elude epidemiology and treatment specialists. However, they are crucial to public health and, as such, require a presence in the discourse on the broader issue of the HIV epidemic in our country.

Background: Many pregnant people find no bridge to ongoing specialty or primary care after giving birth, even when clinical and social complications of pregnancy signal need. Black, indigenous, and all other women of color are especially harmed by fragmented care and access disparities, coupled with impacts of racism over the life course and in health care. Methods: We launched the initiative "Bridging the Chasm between Pregnancy and Health across the Life Course" in 2018, bringing together patients, advocates, providers, researchers, policymakers, and systems innovators to create a National Agenda for Research and Action. We held a 2-day conference that blended storytelling, evidence analysis, and consensus building to identify key themes related to gaps in care and root causes of inequities. In 2019, more than 70 stakeholders joined six working groups to reach consensus on strategic priorities based on equity, innovation, effectiveness, and feasibility. Findings: Working groups identified six key strategic areas for bridging the chasm. These include: 1) progress toward eliminating institutional and interpersonal racism and bias as a requirement for accreditation of health care institutions, 2) infrastructure support for community-based organizations, 3) extension of holistic team-based care to the postpartum year and beyond, with integration of doulas and community health workers on the team, 4) extension of Medicaid coverage and new quality and pay-for-performance metrics to link maternity care and primary care, 5) systems to preserve maternal narratives and data across providers, and 6) alignment of research with women's lived experiences. Conclusions: The resulting agenda presents a path forward to remedy the structural chasms in women's health care, with key roles for advocates, policymakers, researchers, health care leaders, educators, and the media.

ABSTRACT
Implementation fidelity is the degree to which an intervention is delivered as intended. Reduced level of implementation fidelity of trichiasis surgery program may be why trichiasis surgery produces unfavourable outcomes follows after surgery. Trichiasis surgery is done to correct trachomatous trichiasis and prevent blindness. Trachomatous trichiasis (TT) is a sign of trachoma which comes as a result of multiple rounds of Chlamydial trachomatis infection which causes recurrent chronic inflammation in the tarsal conjunctiva. This results into conjunctival scaring, entropion, trichiasis and corneal opacification to blindness if left untreated. However, unfavorable outcomes after surgery are frequent. This study measured the level of implementation fidelity of trichiasis surgery and the factors associated with trichiasis surgery outcomes in Northern and Eastern Uganda.
We conducted a cross-sectional survey among health workers implementing Trichiasis surgery programmes in Eastern and Northern Uganda; from December 2019 to March 2020. A structured questionnaire and direct observations of Trichiasis surgeries were used to collect quantitative data on implementation fidelity. Level of fidelity programme content, coverage, duration, and methods of delivery, exposure and participants’ responsiveness were assessed.  Multiple logistic regression models were used to report adjusted odds ratio for factors associated with implementation fidelity for Trichiasis surgery. Data was analyzed using STATA software and for all statistical analysis a p-value of <0.05 was considered statistically significant.
A total of 408 participants which included; 253 Trichiasis nurse and Trichiasis case finders were surveyed and 155 ophthalmology clinical officers and consultant ophthalmologist were directly observed and surveyed during Trichiasis surgery operations. The overall level of fidelity implementation was 14.3%.  Out of these, the level of fidelity to programme content was 46.08% (189), coverage 51.72% (212), duration 31.86% (129), methods of delivery 82.80% (338), exposure 42.16% (172), and participants’ responsiveness 17.2% (71). Factors which were less likely associated with implementation fidelity for Trichiasis surgery programmes were quality of delivery (OR=0.44, 95% CI [0.27- 0.72], p=0.001), facilitation and sustainability strategies (OR=0.10, 95% CI [0.04 - 0.22], p=0.001), characteristics of patients (OR=0.11, 95% CI [0.01 - 0.17], p<0.001), Participants’ responsiveness (OR= 0.05, 95% CI [0.01 0.17], p<0.001), and structural/ organizational (OR=0.54, 95% CI [0.34 - 0.85], p=0.008). However, programme content (OR=8.1. 95% CI [1.71 - 38.58], p<0.001, and characteristics of the community (OR=19.83, 95% CI [8.60 - 45.70], p=0.001 were significantly more likely to increase the level of fidelity. There were five themes emerged from the qualitative data on barriers; (1) surgical related factors; (2) trichiasis surgery patient related factors; (3) environmental and geographical related factors; (4) health resources and financing challenges; and (5) the characteristics of trichiasis surgeon. The facilitators were; (1) Integration of trichiasis surgery program components into PHC package; (2) patriotization of health resources; (3) training and retraining of trichiasis surgeons; (4) facilitation and sustainability strategies; and (5) partnership with IPs.
Implementation fidelity of the Trichiasis surgery programme was found low. Trichiasis surgery programme outcomes can only improve if the level of implementation fidelity is high. This can only be achieved if the potential associated moderating factors such as; facilitation and sustainability strategies, quality of delivery, patient characteristics, and programme content are improved and critical to successfully translate evidence-based interventions into practice.
Keywords: The measure of Implementation fidelity, Trachomatous Trichiasis surgery, moderating factors