In the U.S., diabetes mellitus cases have been increasing, from 25 million in 2010 to 29 million in 2012. Healthy People 2020, the U.S. National Health Agenda, has established specific goals and objectives for diabetes. In the U.S., prevalence of pre-diabetes and diabetes for adult Hispanics was 38% and 12%, respectively, in 2012. The total estimated diabetes cost in the U.S. has been increasing, from $176 billion in 2007 to $245 billion in 2012. The current study had two research hypotheses; the formative phase was expected to demonstrate a need for a community-based Type 2 Diabetes Mellitus (T2DM) self-management intervention for Spanish-speaking Hispanics. Random Control Trial (RTC) was expected to demonstrate the potential impact in preventing and managing T2DM. Methods. A community-based lifestyle education curriculum was translated into Spanish, and adapted to Hispanic culture. This study includes three phases: 1) a formative phase; 2) a two-group pilot RCT with Hispanic Living with Diabetes (HBLD) and a delayed treatment condition; and 3) post-HBLD focus groups held with three participating groups of HBLD. Results. Of 60 participants screened in the formative phase, 62% had A1c > 5.7%, and 75% did not have medical insurance. Of 6 participants who completed the pilot, A1c decreased for all six participants. Of 67 participants screened in phase 2, 61% had A1c > 5.7%. Of 30 HBLD participants in the RCT, baseline versus 3-month mean A1c increased 0.2 for the delayed control group (n = 10) and did not experience any change for the intervention group (n = 11). The difference in A1c change from baseline to follow up between treatment groups was not statistically significant (Kruskal Wallis, p < 0.05). Diabetes knowledge and SCT variables change from baseline to follow-up between groups were not statistically significant. Major themes identified in focus group discussions included barriers to access to health and nutrition services, the value of having a Spanish-speaking Hispanic as a health educator, and barriers to recruiting community members as promotoras. Implications. HBLD has potential to reduce complications of diabetes among Hispanic participants by providing education to those who may not otherwise have access to it. / Ph. D.

Poor diet and physical inactivity contribute to excessive weight and related diseases in the United States. Given the increasing rates of adult overweight and obesity among Americans, there is a need to develop and implement effective prevention and treatment strategies to decrease the public health burden of obesity-related chronic diseases. Faith-based organizations (FBOs) provide a unique setting and partnership opportunity for delivering evidence-based programs into communities that can be sustained. The federally funded Virginia Supplemental Nutrition Assistance Program Education (SNAP-Ed) delivered through Virginia Tech's Cooperative Extension and Family Nutrition Program, utilizes evidence-based programs to promote healthy eating and physical activity among limited income populations. The Virginia SNAP-Ed Volunteer Led Nutrition Education Initiative uses SNAP-Ed agents and educators to reach limited income populations by training and coordinating volunteers from communities to deliver nutrition education programs. However, these partnerships and training initiatives have been underutilized in FBOs across Virginia. This dissertation research describes four studies conducted to better understand how to facilitate collaborative partnerships and health-promotion programming initiatives between academic/extension educators and FBOs to build capacity and inform future initiatives within VCE. Study one conducted a literature review to examine FBO characteristics and multi-level strategies used to implement nutrition and physical activity interventions. Study two examined VCE SNAP-Ed agents' perspectives on FBO partnerships to deliver health programming. Study three assessed three FBOs and their member health needs to identify policies, systems and environments to support healthy lifestyles. Study four examined the acceptability of Faithful Families, a faith-based nutrition and physical activity program delivered in a rural church, and explored ways to build capacity for program sustainability through input from stakeholder partners. Results across studies yielded information which helped to identify and prioritize strategies for promoting FBO partnerships within VCE and helped to generate questions that merit further investigation to identify specific culturally relevant strategies for promoting health in FBOs. This exploratory body of research contributes to the field by describing relevant opportunities for academic sectors to partner with FBOs using participatory approaches to increase partnership readiness and build capacity to carry out and sustain health programs within faith settings. / Ph. D. / Unhealthy eating and lack of exercise can lead to obesity and diseases which might have otherwise been prevented. Given the growing population of obese people across the United States, coming up with new ways for treating and preventing obesity is key to help improve the health of Americans. Faith-based organizations (FBOs), like churches, mosques and temples, are becoming popular places for delivering health promotion programs. Given that most of these settings are around for a long time in communities, health programs can potentially impact a large number of people and be sustained over a long period of time. The Virginia Supplemental Nutrition Assistance Program Education (SNAP-Ed) is an educational program funded by the government, which provides low-income people and families with health education programs to help them eat better on a budget and live more active lives. In Virginia these SNAP-Ed programs are delivered through Virginia Tech’s Cooperative Extension. Agents who work with Virginia Cooperative Extension (VCE) are hired to train volunteers from different communities in their areas to deliver nutrition education programs. Agents who partner with FBOs can train people from the FBO to deliver health programs in a way that can be sustained. However, few of these training initiatives have taken place across FBOs in Virginia. This dissertation is made up of four studies conducted to identify strategies and opportunities for promoting health and increasing partnerships between VCE and FBOs. Study one involved a literature review to identify strategies used in nutrition and physical activity programs taking place in FBOs. Study two examined SNAP-Ed agents’ perspectives towards partnering with FBOs to deliver health programs. Study three surveyed three FBOs to identify health interests and opportunities to support healthy lifestyles. Study four conducted a faith-based nutrition education program in a small rural church and interviewed partners involved in the program planning and delivery regarding various components of the project. Collective results from this body of dissertation research informed new and better ways for VCE staff to partner with faith communities throughout Virginia and identified strategies for promoting health in FBOs that better fit their unique needs and culture.

Clinicians in low and middle-income countries (LMIC) face many challenges, including high patient-to-staff ratios, limited resources, and inconsistent access to electricity. This research aimed to improve health outcomes in LMIC through an enlightened understanding of challenges associated with healthcare technology. To understand LMIC barriers to acquiring, maintaining, and repairing medical equipment, a community-based participatory study was conducted at three clinical settings in southern Malawi. Thirty-six clinical staff participated in surveys and focus groups to provide information on medical device challenges. Results from the study emphasize the importance of community-based participatory innovation to improve global health. Many clinical staff expressed frustration regarding inability to prevent patient mortality attributed to equipment failure. Data from the community-based participatory study of medical technology conducted in Malawi revealed key insights for designing for low and middle income countries, and more specifically, for communities in southern Malawi. Specifically, partner communities identified mechanical suction machines as a top priority for design innovation. Working with technical and clinical staff in Malawian communities, a prototype mechanical suction machine was designed and constructed. This work suggests that engineers working in low and middle income countries face a unique sundry of design requirements that require an intimate understanding of the local community, including community leaders, community beliefs and values, and locally available resources. Technology innovation for global health should incorporate community expertise and assets, and health and technical education efforts should be developed to increase working knowledge of medical devices. / Master of Science / Clinicians in low and middle-income countries (LMIC) face many challenges, including high patient-to-staff ratios, limited resources, and inconsistent access to electricity. This research aimed to improve health outcomes in LMIC through an enlightened understanding of challenges associated with healthcare technology. To understand LMIC barriers to acquiring, maintaining, and repairing medical equipment, a community-based participatory study was conducted at three clinical settings in southern Malawi. Thirty-six clinical staff participated in surveys and focus groups to provide information on medical device challenges. Results from the study emphasize the importance of community-based participatory innovation to improve global health. Many clinical staff expressed frustration regarding inability to prevent patient mortality attributed to equipment failure. Data from the community-based participatory study of medical technology conducted in Malawi revealed key insights for designing for low and middle income countries, and more specifically, for communities in southern Malawi. Specifically, partner communities identified mechanical suction machines as a top priority for design innovation. Working with technical and clinical staff in Malawian communities, a prototype mechanical suction machine was designed and constructed. This work suggests that engineers working in low and middle income countries face a unique sundry of design requirements that require an intimate understanding of the local community, including community leaders, community beliefs and values, and locally available resources. Technology innovation for global health should incorporate community expertise and assets, and health and technical education efforts should be developed to increase working knowledge of medical devices.

Human life is to be universally cherished and valued. Policies about how to value lives are often developed following gross human rights violations. Some of the most horrific violations have occurred under the guise of biomedical and behavioral research. As a result, policies have been developed to protect participants. Presumably, the primary responsibility of the researcher is their protection. There are, however, potential tensions between protections and research agendas, which set the occasion for over selection of participants with vulnerabilities. This dynamic may establish competing contingencies that devalue, and potentially harm, participants. Power imbalances inherent in the researcher-participant relationship establish the researcher as the dominant knowledge seeking authority and the participant as the subservient subject. Ideally, research in applied behavior analysis is driven by a steadfast orientation toward the enhancement of human life and the amelioration of suffering. The purpose of this paper is to present an analysis of human rights trends in the Journal of Applied Behavior Analysis. The dependent measures are based on ethical principles established for the protection of participants and recommendations concerning participatory research practices in applied behavior analysis. The results indicate that in some cases, protections have been minimally reported. Furthermore, power imbalances are highly likely given the processes and outcomes reported. The trends appear to be moving in an unfavorable direction in most cases. Findings are discussed on three levels: 1) a conceptual analysis of potential contingencies that influence applied behavior analytic research, 2) considerations around coloniality, and, 3) recommendations to neutralize and diffuse power imbalances to ensure the applied spirit of the science is actualized.

BACKGROUND: Practitioners of complementary and alternative medicine (CAM) therapies are an important and growing presence in health care systems worldwide. A central question is whether evidence-based behavior change interventions routinely employed in conventional health care could also be integrated into CAM practice to address public health priorities. Essential for successful integration are intervention approaches deemed acceptable and consistent with practice patterns and treatment approaches of different types of CAM practitioners - that is, they have context validity. Intervention development to ensure context validity was integral to Project CAM Reach (CAMR), a project examining the public health potential of tobacco cessation training for chiropractors, acupuncturists and massage therapists (CAM practitioners). This paper describes formative research conducted to achieve this goal. METHODS: Intervention development, undertaken in three CAM disciplines (chiropractic, acupuncture, massage therapy), consisted of six iterative steps: 1) exploratory key informant interviews; 2) local CAM practitioner community survey; 3) existing tobacco cessation curriculum demonstration with CAM practitioners; 4) adapting/tailoring of existing curriculum; 5) external review of adaptations; 6) delivery of tailored curriculum to CAM practitioners with follow-up curriculum evaluation. RESULTS: CAM practitioners identified barriers and facilitators to addressing tobacco use with patients/clients and saw the relevance and acceptability of the intervention content. The intervention development process was attentive to their real world intervention concerns. Extensive intervention tailoring to the context of each CAM discipline was found unnecessary. Participants and advisors from all CAM disciplines embraced training content, deeming it to have broad relevance and application across the three CAM disciplines. All findings informed the final intervention. CONCLUSIONS: The participatory and iterative formative research process yielded an intervention with context validity in real-world CAM practices as it: 1) is patient/client-centered, emphasizing the practitioner's role in a healing relationship; 2) is responsive to the different contexts of CAM practitioners' work and patient/client relationships; 3) integrates relevant best practices from US Public Health Service Clinical Practice Guidelines on treating tobacco dependence; and 4) is suited to the range of healing philosophies, scopes of practice and practice patterns found in participating CAM practitioners. The full CAMR study to evaluate the impact of the CAMR intervention on CAM practitioners' clinical behavior is underway.

Introduction: Community coalitions with public health-related missions are formal, semi-permanent, action-oriented partnerships comprised of community members, representatives of government agencies, policymakers, and academic partners. Despite their potential to promote sustainable change, coalitions have had mixed success in effecting long-term improvements in community health. There is a need to assist them in developing strategies for improving and sustaining their functionality. The purpose of this study was to improve understanding of the elements of coalition success and sustainability that are vital to health-related community-based participatory research. Methods: Although the literature describes coalition functions for effecting sustainable programs and policies, most research reports on individual programs only, rather than looking at the breadth of community coalitions and the commonalities that contribute to their effectiveness. Semi-structured interviews (N = 42) with academic and community partners followed by a grounded theory analysis of the data address this gap and provide theoretical underpinnings of factors sustaining coalition effectiveness. Results: Seven domains emerged: (1) Characteristics related to coalition structure and processes; (2) Partner characteristics, e.g., diversity, patience, flexibility, expertise; (3) Community characteristics, e.g., capacity, ownership; (4) Partnership dynamics and synergy; (5) Tangible benefits; (6) Available resources, and; (7) Project characteristics. In all, 70 elements representing these categories influenced coalition effectiveness over time. Discussion: Sustained effectiveness means continual improvement, ongoing development of skills and structures to support positive change, and expanded program or policy activities that benefit stakeholders. Whereas community researchers have yet to reach consensus on the universal elements of sustainability, this study expands knowledge of the factors contributing to coalition effectiveness beyond initial project implementation.

abstract: Contemporary urban food security in the US is influenced by complex, multidimensional, and multi-scale factors. However, most assessment methods and intervention efforts in food security research are: 1) narrowly focused on environmental factors (i.e. the presence or absence of quality food outlets), 2) divorced from the human dimension and, 3) ultimately disempower communities to affect change at the local level. New approaches are needed to capture the lived experiences and unique perspectives of people potentially most vulnerable to food insecurity, while also empowering people to become change agents in their lives and in the wider community. This thesis argues that sustainability problem solving frameworks such as transformational sustainability research (TSR), and community-based participatory research (CBPR) provide promising bases from which to address these deficiencies. Through interactive workshops with youth in Canyon Corridor, a neighborhood in Phoenix, Arizona, I demonstrate the potential of concept mapping, sketch mapping, and intervention mapping methods that prioritize participation and co-production of knowledge to: 1) better understand the contextual, community-identified factors that contribute to food security or food insecurity, 2) identify and adapt interventions for the local context and, 3) promote community agency and action. Workshop outcomes suggest the relevance of these frameworks and methods, and the potential for more people- and place-based approaches to food security research. / Dissertation/Thesis / M.A. Sustainability 2012

Submitted by Erika Demachki (erikademachki@gmail.com) on 2017-05-15T19:31:47Z No. of bitstreams: 2 Tese - Cristiane José Borges - 2017.pdf: 6795387 bytes, checksum: df3f07fbc7383b232fa129143a36710f (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-05-16T12:07:16Z (GMT) No. of bitstreams: 2 Tese - Cristiane José Borges - 2017.pdf: 6795387 bytes, checksum: df3f07fbc7383b232fa129143a36710f (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-05-16T12:07:16Z (GMT). No. of bitstreams: 2 Tese - Cristiane José Borges - 2017.pdf: 6795387 bytes, checksum: df3f07fbc7383b232fa129143a36710f (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-03-27 / INTRODUCTION: The process of population aging is a worldwide phenomenon and, simultaneously, a new social role emerges - the informal caregiver-, seen as an essential component to promote elderly’s quality of life in some dependency situation at home. OBJECTIVE: To describe the construction and implementation of care and support strategies for elderlies’ informal caregivers through the Community Based Participatory Research. METHOD: A descriptive study guided by Community Based Participatory Research (CBPR) principles and carried out through the organization of a Community Advisory Committee (CAC), which involved academic and community participants. The study was attended by 384 people, nine community partners, 255 professionals working in family health strategies and 120 elderlies’ informal caregivers. The research was divided into the following phases: 1 - establishment of the community partnership; 2 - identification of problems related to elderly’s informal caregiver; 3 - prioritization of problems related to elderly’s informal caregiver; 4 - capacity survey of community strengths, dynamics and resources; 5 – arrangement of strategies, method, support and care interventions to elderly’s informal caregiver; 6 - implementation of strategies, method, support and care interventions to elderly’s informal caregiver; 7 - data analysis by CAC members; 8- dissemination of results obtained with CAC partnership; 9 - maintenance, CAC sustainability and partnerships evaluation. For the results’ analytical process, the content analysis proposed by Bardin was used for qualitative data and the descriptive statistical analysis was used for quantitative data. The Bioecological Theory of Human Development was adopted as a complementary basis for data analysis. RESULTS: Through the CAC constitution, there were identified, in a collective way, 17 problems faced in the elderly’s informal caregiver daily life. The use of the Severity, Urgency and Trend matrix allowed these problems prioritization for decision making. This process mobilized the construction of an action plan composed by five strategies: 1 - teaching of CAC members about the concepts recommended to define the caregiver role; 2 -raising the knowledge of Family Health Strategy professionals about the importance of including the informal caregiver as a care focus; 3 - performance of the 1st Multiprofessional Care Meeting for Elderly and Informal Caregiver; 4 - recording of the city’s informal caregivers of elderly people; 5 - qualification of the elderlies’ informal caregivers. CONCLUSION: The use of Community Based Participatory Research enabled the community partners’ empowerment, that mobilized themselves in support of elderlies’ informal caregivers, developing actions that included the mapping of the city’s informal caregivers of elderly people, mobilization and qualification of the Family Health Strategy professionals, and the organization of care spaces. In this process, it was verified that this research approach strengthens health democratization by promoting greater involvement and social protagonism of community partners, creating ideas and concrete actions for the establishment of care strategies for the elderlies’ informal caregivers. / INTRODUÇÃO: O processo de envelhecimento populacional é um fenômeno mundial e, concomitante a ele, emergiu um novo papel social – o cuidador informal –, visto como uma peça elementar para promover a qualidade de vida do idoso em alguma situação de dependência no domicílio. OBJETIVO: Descrever a construção e a implementação de estratégias de atenção e suporte aos cuidadores informais de idosos por meio da Pesquisa Participante Baseada na Comunidade. MÉTODO: Estudo descritivo guiado pelos princípios da Pesquisa Participante Baseada na Comunidade e realizado a partir da organização de um Comitê de Assessoria Comunitária (CAC), que envolveu participantes acadêmicos e da comunidade. Participaram do estudo 384 pessoas, sendo nove parceiros da comunidade, 255 profissionais que atuam nas estratégias saúde da família e 120 cuidadores informais de idosos. A investigação foi dividida nas seguintes fases: 1 - formação de parceria com a comunidade; 2 - identificação de problemas relacionados ao cuidador informal de idoso; 3 - priorização de problemas relacionados ao cuidador informal de idoso; 4 - levantamento das capacidades de pontos fortes, dinâmicas e recursos da comunidade; 5 - planejamento de estratégias, método e intervenções de atenção ao cuidador informal de idoso; 6 - implementação de estratégias, método e intervenções em atenção ao cuidador informal de idosos; 7 - análise dos dados pelos membros do CAC; 8 - divulgação dos resultados obtidos com a parceria do CAC; 9 - manutenção, sustentabilidade do CAC e avaliação das parcerias. Para o processo analítico dos resultados, utilizou-se a análise de conteúdo proposta por Bardin, para os dados qualitativos, e a análise estatística descritiva, para os dados quantitativos. Adotou-se como fundamentação complementar para análise dos dados a Teoria Bioecológica do Desenvolvimento Humano. RESULTADOS: A partir da constituição do CAC identificaram-se, de maneira coletiva, 17 problemas enfrentados no cotidiano do cuidador informal de idoso. O uso da matriz de Gravidade, Urgência e Tendência possibilitou a priorização desses problemas para a tomada de decisão. Esse processo mobilizou a construção de um plano de ação composto por cinco estratégias: 1 - capacitação dos membros do CAC sobre os conceitos preconizados para definir o papel do cuidador; 2 - sensibilização dos profissionais da Estratégia Saúde da Família sobre a importância de incluir o cuidador informal como alvo de cuidados; 3 - realização do I Encontro Multiprofissional de Atenção à Pessoa Idosa e ao Cuidador Informal; 4 - cadastramento dos cuidadores informais de idosos do município; 5 - qualificação dos cuidadores informais de idosos. CONCLUSÃO: O uso da Pesquisa Participante Baseada na Comunidade possibilitou o empoderamento dos parceiros comunitários que se mobilizaram em prol dos cuidadores informais de idosos, desenvolvendo ações que incluíram o mapeamento dos cuidadores informais no município, a mobilização e a qualificação de profissionais da Estratégia Saúde da Família, e também a organização de espaços de cuidados. Nesse processo, constatou-se que essa abordagem de pesquisa fortalece a democratização da saúde por promover maior envolvimento e protagonismo social dos parceiros da comunidade, gerando ideias e ações concretas para o estabelecimento de estratégias de atenção aos cuidadores informais de idosos.

Little is known about the healthcare experiences of lesbian, gay, and bisexual (LGB) young adults (ages 18-24) and even less is known about LGB college students (ages 18-24). Helping LGB college students effectively access appropriate, sensitive healthcare has the potential to reduce negative long-term health consequences. Therefore, the purpose of this study was to describe the healthcare experiences of LGB college students (ages 18-24) in the local college community using community-based participatory research (CBPR). Three online synchronous focus groups and one online individual interview were conducted with 19 LGB college students between January and February 2011. The focus groups were segmented into lesbian (n= 7), gay (n= 7), and female bisexual (n = 4) groups. One male bisexual was interviewed individually. The mean age of the sample was 20.7 years (SD = 1.2, range = 19-24). The sample was predominately White non-Hispanic (85%). Qualitative content analysis was used to describe the healthcare experiences of lesbian, gay, and bisexual college students in the local community. One overarching theme (not all the same), one main theme (comfort during the clinical encounter), three sub themes (personalizing the clinical encounter, deciding to disclose and social stigma, and seeking support of self-identified sexual orientation) and one preliminary sub theme (perceived confidentiality) emerged from the analysis. One major action emerged from the analysis and supported the development of the social network site (on Facebook) entitled: College Alliance Towards Community Health (CATCH). The mission of CATCH is to provide LGB college students in the local community with a comfortable forum to learn about various healthcare concerns of lesbian, gay, and bisexual college students. Additional implications for nursing practice and implications for further research in the LGB college community are addressed.

BACKGROUND/RATIONALE: Persons with intellectual and developmental disabilities (pIDD) face barriers to quality health care, including psychiatric care, that result in worse health outcomes. While the mental healthcare community is increasing attention towards the psychiatric needs of pIDD, there continues to be a deficit of knowledge regarding psychiatric conditions, including suicidality. Engaging in community-based participatory research (PAR) with pIDD is the ethical way to address these deficits. An academic researcher (AR) must first educate herself on lessons from disability rights activism and disability bioethics. OBJECTIVE: Apply the intertwining history and principles of disability rights movements and disability bioethics to lessons learned from previous PAR with pIDD in order to propose a PAR project that aims to alleviate knowledge deficits regarding suicidality in pIDD. METHODS/APPROACH: Historical research will focus on landmark texts in disability rights movements and disability bioethics. Lessons learned from previous PAR is mostly obtained from reflexive accounts on behalf of the AR and outside of psychiatry. Analyzing these sources will result in a proposal of six principles that can guide the AR when ethically engaging in PAR with pIDD. RESULTS: The AR must understand the history of society valuing non-disabled lives over disabled lives, inclusive of pIDD, and the social model of disability as it relates to the human variation model. When engaging with pIDD, the AR can question the traditional definition of vulnerable populations, challenge the group to progress beyond informed consent, continually support a capacity-building approach to research and power-sharing skills, and embrace empowerment to enact political change. DISCUSSION: ARs, pIDD, and pIDD advocates must not accept the dearth of knowledge regarding psychiatric conditions, including life-threatening suicidality, in pIDD. The medical community should prioritize PAR with persons with pIDD to elucidate psychiatric conditions in pIDD that result in more efficacious and compassionate treatment. This proposal outlines major principles through which the AR can move forward ethically by engaging in PAR with pIDD. / Urban Bioethics