Dissemination of prevention-focused evidence-based programs (EBPs) from research to community settings may improve population health and reduce health disparities, but such flow has been limited. Academic-community partnerships using community-based participatory research (CBPR) principles may support increased dissemination of EBPs to community-based organizations (CBOs). This qualitative study examined the EBP-related perceptions and needs of CBOs targeting underserved populations. As part of PLANET MassCONECT, a CBPR study, we conducted six key informant interviews with community leaders and four focus groups with CBO staff members in Boston, Worcester and Lawrence, Massachusetts, in 2008. Working definitions of EBPs among CBO staff members varied greatly from typical definitions used by researchers or funders. Key barriers to using EBPs included: resource constraints, program adaptation challenges and conflicts with organizational culture. Important facilitators of EBP usage included: program supports for implementation and adaptation, collaborative technical assistance and perceived benefits of using established programs. This exploratory study highlights differences among key stakeholders regarding the role of evidence in program planning and delivery. An updated perspective should better incorporate CBO perspectives on evidence and place greater, and much needed, emphasis on the impact of context for EBP dissemination in community settings.
Understanding the heterogeneity of groups along the vaccine hesitancy continuum presents an opportunity to tailor and increase the impact of public engagement efforts with these groups. Audience segmentation can support these goals, as demonstrated here in the context of the 2009 H1N1 vaccine. In March 2010, we surveyed 1569 respondents, drawn from a nationally representative sample of American adults, with oversampling of racial/ethnic minorities and persons living below the United States Federal Poverty Level. Guided by the Structural Influence Model, we assessed knowledge, attitudes, and behaviors related to H1N1; communication outcomes; and social determinants. Among those who did not receive the vaccine (n = 1166), cluster analysis identified three vaccine-hesitant subgroups. Disengaged Skeptics (67%) were furthest from vaccine acceptance, with low levels of concern and engagement. The Informed Unconvinced (19%) were sophisticated consumers of media and health information who may not have been reached with information to motivate vaccination. The Open to Persuasion cluster (14%) had the highest levels of concern and motivation and may have required engagement about vaccination broadly. There were significant sociodemographic differences between groups. This analysis highlights the potential to use segmentation techniques to identify subgroups on the vaccine hesitancy continuum and tailor public engagement efforts accordingly.
Background: Graphic health warnings (GHWs) on cigarette packages offer the potential to support tobacco cessation and prevention of initiation. Guidance for supporting implementation at the local level is limited, which can lead to missed opportunities to amplify the health impact of GHWs. This study examines the potential for local organizations engaged in tobacco control in underserved communities to support GHW implementation.Materials and Methods: Key informant interviews were conducted with 20 leaders in the three partner communities of Boston, Lawrence, and Worcester, Massachusetts. Data were analyzed using a combination of inductive and deductive methods, grounded in a framework analysis approach.Results: First, participants expected local organizations to play a diverse range of roles to support GHW policy implementation, ranging from convening local actors to offering complementary health education activities. Second, there is a need for external agencies to actively support local organizations during the pre-implementation and implementation phases, e.g., by engaging local organizations and providing resources and technical assistance. Finally, participants noted concerns about potential disconnects between the GHWs and the needs of underserved populations.Discussion: With the necessary supports, local community organizations can be important implementation partners to maximize the impact of GHWs and ensure that benefits accrue to members of underserved communities.
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