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Creative ability is an important outcome of developmental support programs, as it helps to lay the foundation for better long-term participation and well-being. Children with learning differences risk underdeveloping this potential, especially those in rural, low-resource African settings. This study aimed to determine the potential outcomes of Create2Grow, a new community-based occupational therapy visual arts group intervention for children aged 8 to 12 years with mild to moderate neurodevelopmental disorders, using a case series research design with eight children recruited via convenience sampling. The intervention had a large clinical effect on participants' caregiver-rated Canadian Occupational Performance Measure scores (d = 1.5) and clinician-rated Creative Participation Assessment scores (d = 1.76) from pre- to post-intervention. Create2Grow was also rated as highly in demand, acceptable, and practical for the target group. Low study attrition rates showed that the intervention could be effectively implemented at a local school within the community. Create2Grow is a promising solution to promoting the creative ability of children with learning differences in rural, low-resource settings in Africa.

Introduction In Uganda, HIV‐related stigma and discrimination remain major barriers to HIV care engagement and serostatus disclosure. While serostatus disclosure can improve access to, engagement with and retention in HIV care, many people living with HIV (PLWH) hesitate to disclose due to fear of negative consequences. Traditional healers (THs) are trusted community members offering accessible and confidential psychosocial support. This study explores the role of THs in facilitating HIV status disclosure among PLWH disengaged from clinical care in southwestern Uganda. Methods This qualitative sub‐study was nested within a cluster‐randomized trial evaluating the effectiveness of THs supporting PLWH to engage with HIV care in southwestern Uganda. In‐depth semi‐structured individual interviews were conducted with 22 healers (14 female) and 16 PLWH (10 female) from August 2023 to June 2024. Interviews explored experiences with HIV care and healer‐facilitated support to engage with and remain in HIV care. Data was analysed thematically, with particular attention to serostatus disclosure practices. Results Four key themes emerged: (1) PLWH, who receive care from TH practices, preferred THs over healthcare workers to disclose their HIV serostatus due to perceived trust, confidentiality and personalized care; (2) HIV‐related stigma and fear of domestic violence hindered disclosure within families, but disclosure to healers offered a safer alternative; (3) in some cases, THs were the first individuals to whom PLWH disclosed their status; and (4) THs actively encouraged and facilitated serostatus disclosure by PLWH to family members, offering guidance and mediating difficult conversations. These findings highlight the critical role of THs in reducing barriers to disclosure and fostering supportive networks to improve the quality of life for PLWH. Conclusions THs provide a culturally sensitive and trusted avenue for HIV status disclosure in rural Uganda. Their unique position within the community allows them to address stigma, build trust and facilitate safe disclosure practices. Integrating healers into HIV care through training and collaboration with formal healthcare systems could enhance linkage, adherence, retention and overall care outcomes for PLWH. Future research should explore scalable models to leverage the positive influence and potential of THs to improve HIV care delivery.

Despite evidence of increasing health uptake and engagement, little is known about the feasibility of undertaking online community engagement and research, especially during a pandemic. 12 Salmons (2016) introduced an e‐research framework that facilitates a holistic approach to undertake community engagement and qualitative research online. 13 Furthermore, social media platforms have been found to be valid tools to engage with communities during times of crises. 13‐15 Consequently, the NEON team decided to adapt the intervention such that community engagement, delivery and evaluation occurred virtually, utilizing the software Zoom. Meetings could also be recorded with the participants’ permission and accessed later to reflect on specific points and/or for those who missed meetings. Since COVID‐19, there has been an increase in anxiety, depression and other mental health morbidity, which may have impacted on CF’s proactiveness to participate online. Other limitations and/or risks of virtual meetings include: (a) loss of body language and non‐verbal cues, particularly if individuals switch off their cameras and (b) risk worsening health inequities by reliance on digital methods as the highest risk, hardest to reach populations are likely those who experience greater digital poverty. 16 After conducting online parent/carer workshops to gather feedback around the COVID‐19 experience, the G2KCP project team is undertaking qualitative focus group discussions (FGD) and semi‐structured interviews online.

Swedish child health centres (CHCs) have created a series of visits for fathers/non-birthing parents. The primary aim was to assess child health nurses’ implementation fidelity of the father/non-birthing parent visits, with a secondary aim of exploring predictor variables for fidelity. In 2017, nurses voluntarily implemented a series of father/non-birthing parent visits in Region Stockholm. Nurses ( n  = 122) completed baseline and 8—12 month follow-up surveys. Multiple imputation was used for missing data. Register data on the number of fathers attending the three-to-five month visit was used. Frequencies of nurses reporting good overall adherence to the home visit, three-to-five week visit, and three-to-five month visit were 86%, 76%, and 68%, respectively. A total of 3,609 fathers attended the three-to-five month visit in 2018, where over half of the visits were at 14 of the 134 CHCs. Multiple linear regression showed that working for a private CHC, seeing more fathers, and nurses’ perceptions of receiving enough support predicted higher three-to-five month visit adherence. After nurses saw eight fathers, they were more likely to adhere to the guidelines.

This paper presents an in-depth case study of the dynamic processes of mutual adjustment that occurred between two professional teams participating in a multicomponent community-based intervention (CBI). Drawing on the concept of social regularities, we focus on patterns of social interaction within and across the two microsystems involved in delivering the intervention. Two research strategies, narrative analysis and structural network analysis, were used to reveal the social regularities linking the two microsystems. Results document strategies and actions undertaken by the professionals responsible for the intervention to modify intersetting social regularities to deal with a problem situation that arose during the course of one intervention cycle. The results illustrate how key social regularities were modified in order to resolve the problem situation and allow the intervention to continue to function smoothly. We propose that these changes represent a transition to a new state of the ecological intervention system. This transformation appeared to be the result of certain key intervening mechanisms: changing key role relationships, boundary spanning, and synergy. The transformation also appeared to be linked to positive setting-level and individual-level outcomes: confidence of key team members, joint planning, decision-making and intervention activities, and the achievement of desired intervention objectives.

BackgroundCommunity-based health interventions have been implemented as a key strategy for achieving improved health outcomes in Ghana. Effectiveness, however, largely depends on the successful implementation of patient–public engagement (PPE). Although several PPE studies have been conducted in Ghana, little research has been done to understand the specific role of PPE in the context of implementing community-based health programmes. This paper, therefore, examines the extent of PPE implementation in three selected community-based health programmes (Community-based Health Planning and Service [CHPS], Community-based Maternal and Child Health and Buruli Ulcer) to understand their specific effects on health outcomes.MethodsThree focus groups, involving 26 participants, were held in three districts of the Ashanti region of Ghana. Participants were mainly health service users involving community health committee members/volunteers, residents and health professionals. They were invited to participate based on their roles in the design and implementation of the programmes. Participants focused on each of Rifkin's spider-gram components. Data were transcribed and analysed descriptively using NVIVO 12 Plus.ResultsPPE implementation was found to be extensive across the three programmes in specific areas such as organisation and resource mobilisation. PPE was more restricted in relation to community needs assessment, leadership and management, particularly for the CHPS and Buruli Ulcer programmes.ConclusionFindings suggest that benefits from community-based health interventions are likely to be greater if PPE can be widely implemented across all dimensions of the spider-gram framework.

To advance our understanding of inclusion oral health and to address the impact of social exclusion upon oral health, this group of papers sets out to provide an argument for the need for social and community-based interventions, theoretically underpinned by pluralistic definitions of evidence-based practice and the radical discourse of health promotion for those experiencing exclusion. Using the definition and framework of inclusion oral health, these papers illustrate the requirement for mixed-methods research, the incorporation of experts by experience in the research process, and the need for co-design and co-produced interventions. The papers in this Special Issue present various sources of evidence used to transform top-down into bottom-up community-based interventions for people experiencing homelessness, people in custody, and families residing in areas of high social deprivation. The first two papers provide the evidence for extreme oral health in those experiencing exclusion, and the final four papers report on the implementation and evaluation of social or community-based interventions. This collection of research papers will be of interest to all those wishing to reduce health inequities. This will be achieved by focusing on prevention, adopting a common risk factor agenda, and incorporating co-design and co-production elements into interventions, to tackle the oral health inequities felt by those most excluded in our societies.

Rodent pests can have major social, economic, and environmental impacts. Their management, therefore, represents a complex socio‐ecological problem involving a network of stakeholders from across different sectors, with diverging and sometimes competing interests. Failure to incorporate stakeholder interests can result in ineffective or unsustainable management programmes, with unintended negative consequences for people and nature. Participatory approaches to decision‐making have been proposed as suitable strategies to tackle complex problems, yet, these processes are often considered too difficult, costly, or time‐consuming to implement. To facilitate a participatory approach to rodent control in Madagascar, we identified and mapped key stakeholders and developed a multisector framework for guiding rodent management programmes based on current literature and expert recommendations. We then carried out interviews and focus groups with stakeholders and end‐users to validate the final framework. The final framework unifies stakeholder interests around the dimensions of People, Resources, Knowledge and Power. Combined application of the stakeholder map and framework provides decision‐makers with the tools to identify stakeholder interests; to explore areas of conflict, as well as areas of agreement; and to ensure that these are addressed within the design of control programmes. As an assessment tool, the framework can also be used to evaluate the responsiveness of programmes to the needs of different stakeholders and assess whether objectives are being reached. We recommend the application of the stakeholder map and framework to encourage and strengthen participatory approaches aimed at rodent pest control. Due to the inclusive and interdisciplinary nature of the framework, it can be applied to address numerous complex social, environmental, and economic issues across scales, sectors, and systems. Read the free Plain Language Summary for this article on the Journal blog. Résumé Les rongeurs nuisibles peuvent avoir des impacts sociaux, économiques et environnementaux majeurs. Leur gestion représente un problème socio‐écologique complexe impliquant un réseau de parties prenantes issues de différents secteurs, aux intérêts divergents et parfois concurrents. Si les intérêts des parties prenantes ne sont pas pris en compte, les programmes de gestion peuvent être inefficaces ou non durables, avec des conséquences négatives inattendues pour les humains et la biodiversité. Les approches participatives de la prise de décision ont été proposées comme des stratégies appropriées pour aborder des problèmes complexes, mais ces processus sont souvent considérés comme trop difficiles, coûteux ou longs à mettre en œuvre. Pour faciliter une approche participative de la lutte contre les rongeurs à Madagascar, nous avons identifié et cartographié les principales parties prenantes et développé un cadre multisectoriel pour guider les programmes de gestion des rongeurs sur la base de la littérature actuelle et des recommandations des experts. Nous avons ensuite mené des entretiens et des groupes de discussion avec les parties prenantes et les utilisateurs finaux pour valider le cadre final. Le cadre final unifie les intérêts des parties prenantes autour de quatre dimensions : Acteurs, Ressources, Connaissances et Pouvoir. L'application combinée de la carte et du cadre des parties prenantes fournit aux décideurs les outils nécessaires pour identifier les intérêts des parties prenantes, pour explorer les zones de conflit et les zones d'accord, et pour s'assurer qu'elles sont prises en compte dans la conception des programmes de contrôle. En tant qu'outil d'évaluation, le cadre peut également être utilisé pour évaluer la réactivité des programmes aux besoins des différentes parties prenantes et déterminer si les objectifs sont atteints. Nous recommandons l'application de la carte et du cadre des parties prenantes pour encourager et renforcer les approches participatives visant à lutter contre les rongeurs nuisibles. En raison de la nature inclusive et interdisciplinaire du cadre, il peut être appliqué pour traiter de nombreuses questions sociales, environnementales et économiques complexes à plusieurs échelles, secteurs et systèmes différents. Read the free Plain Language Summary for this article on the Journal blog.

Objectives: To describe the current prevalence of type 2 diabetes (diabetes) and readiness to change diet and physical activity among Samoans associated with churches in Sydney. Methods: Residents aged >=18 years attending four Samoan churches in Sydney were invited to participate in a church-wide lifestyle intervention. Participants completed questionnaires, anthropometric measurements, provided a non-fasting blood sample for HbA1c and random blood glucose (RBG) measurement, and performed a 6-minute walk test. Obesity was defined using a Pacific body mass index (BMI) threshold >=32 kg/m2 and diabetes if HbA1c was >=6.5%. Results: In total, 131/187 (70%) of Samoans (mean age of 44.1 +- 15 years; Female 52%) participated. Diabetes was present in 33% of the population which included 20% previously diagnosed diabetes, duration 13.4 +- 6.7 years, (HbA1c 8.3 +- 2.5% and RBG 10.2 +- 4.1 mmol/L) and 13% had undiagnosed diabetes (HbA1c 8.1 +- 2.7% and RBG 10.3 +- 4.7 mmol/L). The overall baseline prevalence of obesity, high blood pressure and meeting the physical activity recommendation of >=150 min/wk were 77%, 44% and 38% respectively. Over 90% of participants were contemplating, if not already taking action towards healthier diet choices and increasing physical activity. Conclusions: Prevalence of diabetes and its risk factors were high among Samoans in Sydney with a high proportion with undiagnosed diabetes.

Objective: To identify different patterns of relationship beliefs, and examine how those patterns vary across participants attending classes through different venues: community, reemployment services, and jails. Background: Although there have been increased efforts to provide relationship education to underprivileged and underserved populations in diverse venues, there is little research on how the relationship education needs at different venues may vary. Method: From the perspective of relationship lay theory, the present study used latent class analysis to identify patterns, or classes, of relationship beliefs among participants in community settings (n = 1,144), reemployment services settings (n = 423), and jails (n = 242). Results: Five classes of relationship beliefs emerged: Low Risk, Blind Love, Sliders, Blind Love Sliders, and Control Tolerates. Differences in class membership were observed across the three venues. Being single, having a history of divorce, and no prior relationship education were associated with membership in more risky classes. Conclusion: Distinct patterns of risky relationship beliefs exist among participants in different venues of relationship education. The highprevalence of the Slider class and associated beliefs indicate those beliefs may be particularly prevalent across venues. Implications: The findings point to educational needs of particular groups. For example, information on the issue of sliding is needed when teaching in any setting, but information on control tolerance and blind love sliding is particularly needed when teaching in jails, and to a lesser but still elevated degree in reemployment services.