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Mobilizing community-driven health promotion through community granting programs: a rapid systematic review
Background
Effective health promotion responds to the unique needs of communities. Community granting programs that fund community-driven health promotion initiatives are a potential mechanism to meet those unique needs. While numerous community health-focused programs are available, the various strategies used by granting programs to foster engagement, administer grants and support awardees have not been systematically evaluated. This rapid systematic review explores the administration of community granting programs and how various program components impact process and population health outcomes.
Methods
A systematic search was conducted across three databases: Medline, SocINDEX, and Political Science Database. Single reviewers completed screening, consistent with a rapid review protocol. Studies describing or evaluating community granting programs for health or public health initiatives were included. Data regarding program characteristics were extracted and studies were evaluated for quality. A convergent integrated approach was used to analyze quantitative and qualitative findings.
Results
Thirty-five community granting programs, described in 36 studies, were included. Most were descriptive reports or qualitative studies conducted in the USA. Program support for grant awardees included technical assistance, workshops and training, program websites, and networking facilitation. While most programs reported on process outcomes, few reported on community or health outcomes; such outcomes were positive when reported. Programs reported that many funded projects were likely sustainable beyond program funding, due to the development of awardee skills, new partnerships, and securing additional funding. From the perspectives of program staff and awardees, facilitators included the technical assistance and workshops provided by the programs, networking amongst awardees, and the involvement of community members. Barriers included short timelines to develop proposals and allocate funds.
Conclusions
This review provides a comprehensive overview of health-related community granting programs. Grant awardees benefit from technical assistance, workshops, and networking with other awardees. Project sustainability is enhanced by the development of new community partnerships and grant-writing training for awardees. Community granting programs can be a valuable strategy to drive community health, with several key elements that enhance community mobilization.
Registration
PROSPERO #CRD42023399364.
Journal Article
Extreme Heat and Pregnancy Outcomes: A Scoping Review of the Epidemiological Evidence
Background: Extreme heat caused by climate change is a major public health concern, disproportionately affecting poor and racialized communities. Gestational heat exposure is a well-established teratogen in animal studies, with a growing body of literature suggesting human pregnancies are similarly at risk. Characterization of extreme heat as a pregnancy risk is problematic due to nonstandard definitions of heat waves, and variable study designs. To better focus future research in this area, we conducted a scoping review to assess the effects of extreme heat on pregnancy outcomes. Methods: A scoping review of epidemiological studies investigating gestational heat-exposure and published 2010 and 2020, was conducted with an emphasis on study design, gestational windows of sensitivity, adverse pregnancy outcomes and characterization of environmental temperatures. Results: A sample of 84 studies was identified, predominantly set in high-income countries. Preterm birth, birthweight, congenital anomalies and stillbirth were the most common pregnancy outcome variables. Studies reported race/ethnicity and/or socioeconomic variables, however these were not always emphasized in the analysis. Conclusion: Use of precise temperature data by most studies avoided pitfalls of imprecise, regional definitions of heat waves, however inconsistent study design, and exposure windows are a significant challenge to systematic evaluation of this literature. Despite the high risk of extreme heat events and limited mitigation strategies in the global south, there is a significant gap in the epidemiological literature from these regions. Greater consistency in study design and exposure windows would enhance the rigor of this field.
Journal Article
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Pandemic Pregnancy Experiences and Risk Mitigation Behaviors: COVID-19 Vaccination Uptake in Canada
Background: Pregnant people in Canada during the pandemic faced complex decision-making related to COVID-19 exposure risks and the safety of mitigation measures, including vaccines. To help inform future infectious disease–health promotion, we assessed pandemic pregnancy experiences and COVID-19 risk mitigation strategies. Methods: Respondents, pregnant at any time after January 2020 in Canada, completed an online, cross-sectional, descriptive survey from September 2021 to February 2022. Logistic regression was used to identify predictive factors associated with COVID-19 vaccine uptake and history of infection. Results: A purposive sample of predominantly non-racialized, high socioeconomic status women (n = 564), 58.2% primigravid during the pandemic, reported high COVID-19 vaccine uptake (87.4%). Educational attainment beyond high school predicted COVID-19 vaccination (college AOR: 2.72, CI: 1.24–5.94, p < 0.001; university AOR 4.01, CI: 1.91–8.40, p < 0.001; post-graduate university AOR: 7.31, CI: 2.84–18.81, p < 0.001). Immigrant status reduced the likelihood of COVID-19 vaccination (AOR: 0.20; CI: 0.09–0.49, p < 0.001). Racialized participants were 2.78-fold more likely to report infection (CI:1.19–6.50, p = 0.018). Conclusions: COVID-19 vaccination uptake was very high; however, vaccine hesitancy was evident among immigrants, with racialized participants more likely to report a history of COVID-19 infection. Tailored public health messaging using a health equity lens may yield more robust vaccine uptake for future infectious respiratory disease outbreaks.
Journal Article
From SARS to pandemic influenza: the framing of high-risk populations
The 2003 global outbreak of severe acute respiratory syndrome (SARS) was a wake-up call for health systems in Canada, with realization of occupational health risks faced by health care workers and first responders in public health emergency response. The need for investment in critical social infrastructure—including explicitly articulated plans—became a priority for managing future pandemics. Over the past 15 years, pandemic planning has evolved with the adoption of a whole-of-society approach to disaster risk reduction. There is recognition of the social gradient of risk, which emerges from the interaction between social determinants of health, risk of exposure, and adverse impacts from a pandemic. Additionally, there is better understanding of the benefits of planning according to functional needs, rather than deficit-oriented labelling. In this paper, we reflect on how the framing of vulnerable or high-risk populations has evolved since SARS. Looking to the future, we present the imperative for the creation of institutional space for engagement of high-risk populations in pandemic planning processes, including participatory governance. Innovative consultation strategies are needed to enhance collective asset literacy and ensure planning is adaptive to the changing social fabric. Progressive pandemic planning in the next decade must be inclusive and sensitive to modern definitions of family, varied abilities, cultural practices and gender and sexual diversity, thereby reflecting a whole-of-society approach to disaster risk reduction.
Journal Article
The pandemic experiences of Ontario perinatal providers: a qualitative study
Background
The COVID-19 pandemic has produced widespread disruptions for healthcare systems across Canada. Perinatal care in Ontario, Canada was subject to province-wide public health restrictions, reallocation of hospital beds and human health resources. To better understand the impacts of the pandemic on Ontario perinatal care, this study explored the perspectives of perinatal care providers about their clinical COVID-19 pandemic experiences.
Methods
Semi-structured key informant virtual interviews were conducted between August 2021 and January 2022 with 15 Ontario-based perinatal care providers. Recorded interviews were transcribed, and thematic content analysis used to identify major themes and subthemes.
Results
Participants were mainly women, practicing in Eastern and Central Ontario as health providers (obstetricians, nurses, midwives), allied regulated health professionals (social worker, massage therapist), and perinatal support workers (doula, lactation consultant). Major themes and subthemes were identified inductively as follows: (1) Impacts of COVID-19 on providers (psychosocial stress, healthcare system barriers, healthcare system opportunities); (2) Perceived impacts of COVID-19 on pregnant people (psychosocial stress, amplification of existing healthcare barriers, influences on reproductive decision making; minor theme- social and emotional support roles); (3) Vaccine discourse (provider empathy, vaccines and patient family dynamics, minor themes- patient vaccine hesitancy, COVID-19 misinformation); and (4) Virtual pregnancy care (benefits, disadvantages, adaptation of standard care practices).
Conclusions
Perinatal care providers reported significant stress and uncertainty caused by the COVID-19 pandemic and evolving hospital protocols. Providers perceived that their patients were distressed by both the pandemic and related reductions in pregnancy healthcare services including hospital limits to support companion(s). Although virtual pregnancy care impaired patient-provider rapport, most providers believed that the workflow efficiencies and patient convenience of virtual care is beneficial to perinatal healthcare.
Journal Article
Sexual behaviors at home and abroad: an online survey of Canadian young adult travelers
Background
For young adults, travel- an accessible and aspirational experience- may be accompanied by high-risk lifestyle behaviors abroad, which in turn, increases the risk of sexually transmitted and blood-borne infections (STBBI). This study aimed to examine sexual and risk behaviors of young Canadian adults both at-home and during international travel.
Methods
Sexually-active Canadians, aged 18-25 years (
N
= 646) who travelled abroad in 2016, completed an online, cross-sectional survey analyzed by descriptive statistics. Outcome measures included young Canadian adults’ lifestyle risk and sexual behaviors at-home and abroad.
Results
Sexual behaviors, both penetrative and non-penetrative activities, decreased significantly (
p
< 0.001; McNemar test) abroad compared to at-home. International travel elicited a statistically significant increase in alcohol consumption compared to at-home (Wilcoxon,
z
= − 11.341,
p
< 0.001). Partner type (new trip-acquired partner) abroad was associated with a greater number of travel-acquired sexual partners (Mann-Whitney, U = 4901,
p
< 0.001), inconsistent condom use during penetrative sex (U = 7215,
p
= 0.009), and sex under the influence of alcohol (Test of Two Proportions,
p
< 0.001).
Conclusions
Although many young Canadian respondents practiced abstinence in their 2016 travel, for sexually-active travelers, new partner-type was related to high risk sexual behaviors. Young Canadians exhibited sexual risk behaviors both at-home and while travelling; suggesting the need for both domestic and pre-travel sexual health interventions.
Journal Article
Predictive factors associated with sexual activity and consistent condom use during travel abroad: a cross-sectional survey of young Canadian adults
Background
For young adults seeking new experiences, international travel provides opportunities for casual sexual encounters. The aim of this study was to identify the predictive factors associated with travel-associated sex and consistent condom use in a non-random sample of single and partnered young travelers.
Methods
Sexually-active Canadians, aged 18–25 years, who traveled abroad in 2016, were purposively recruited to participate in an online survey. Two binomial logistic regressions were performed to examine the demographic, sexual health and lifestyle factors associated with (1) having sex abroad (
N
= 646), or (2) consistent external condom use abroad (
n
= 271 sexually-active travelers).
Results
Packing condoms for international travel was associated with more than twice the odds of both having sex abroad (AOR: 2.58, 95% CI: 1.47–4.51
p
< 0.001) and using condoms consistently during intercourse (AOR: 2.62, 95% CI: 1.62–5.32,
p
= 0.008). Sex under the influence of alcohol at-home, history of sexually transmitted infections, travel-related plans to have sex and drug consumption were also associated with sex abroad. Consistent external condom use abroad was associated with prior condom use at-home and penetrative sexual practices abroad. Unlike previous studies, gender, sexual orientation and relationship status were not significantly associated with either travel-associated sex nor condom use.
Conclusion
Travelers’ characteristics and domestic sexual behaviors will inform travel health interventions, but our findings support universal promotion of barrier protection during travel regardless of relationship status, sexual orientation or gender identity. Given the increasingly open and fluid nature of sexual expressions and relationships, pre-travel sexual health interventions should be sex-positive, broadly inclusive and promote strategies for safe sexual behaviors while travelling.
Plain English summary
The experience of international travel is often accompanied by risky behaviors including substance use and casual sex. Packing condoms for international travel was associated with a higher likelihood of travel-related sexual activity and consistent condom use. Behaviors at home including sex under the influence of alcohol, and history of sexually transmitted infections, were also linked with travel-related sex, whereas domestic condom use was associated with consistent condom use abroad. These factors can be incorporated in sex-positive, travel-sexual health promotion to ensure safe and responsible sexual activity abroad.
Journal Article