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      Free Time For Wellness: a co-designed intervention utilizing social networks to encourage physical activity for cancer prevention among low resourced mothers

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          Abstract

          Background

          Physical activity is central to chronic disease prevention. Low resource mothers face structural barriers preventing them from increasing their physical activity to reduce their chronic disease risk. We co-designed an intervention, with the ultimate goal of building social cohesion through social media to increase physical activity for low resourced mothers in urban settings.

          Methods

          In 2019, we interviewed 10 mothers of children (< 12 years) living in Washington Heights, Manhattan. The interviews were transcribed and coded for themes that guided the creation of a co-design workshop. Washington Heights-based mothers ( n = 16) attended a co-design workshop to generate the blueprint for the Free Time for Wellness intervention.

          Results

          Mothers in our sample had limited time, external support and resources, which hindered them from increasing their physical activity; we learned that in addition to physical health, mental health was a concern for participants. Participants had varying degrees of self-efficacy and trust in social media. Bringing mothers and researchers together in a co-design workshop, we identified types of physical activities they would enjoy participating in, the ideal time to do so, the kind of childcare they needed, and their preferences for communication with the community champion. The interviews and workshop highlighted the need for a community space that mothers and children could co-occupy. The intervention was designed to be 3 months’ worth of sample programming with one activity per week, rotating between dance, yoga, food pantry visits and group playdates. Participants were invited to bring their children to a space with one room for the ‘participants only’ activity and a second room in which professional childcare providers supervised the children.

          Conclusions

          Through this two-phased co-design process, we created an intervention with mothers in an urban community with the goal of using social media to bring them together for wellness, primarily through increased physical activity. Despite the co-design of this intervention with a specific community, there are some universal applications of our findings, and of the use of co-design workshops, to other settings.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12889-021-11775-9.

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          Most cited references25

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          The spread of behavior in an online social network experiment.

          How do social networks affect the spread of behavior? A popular hypothesis states that networks with many clustered ties and a high degree of separation will be less effective for behavioral diffusion than networks in which locally redundant ties are rewired to provide shortcuts across the social space. A competing hypothesis argues that when behaviors require social reinforcement, a network with more clustering may be more advantageous, even if the network as a whole has a larger diameter. I investigated the effects of network structure on diffusion by studying the spread of health behavior through artificially structured online communities. Individual adoption was much more likely when participants received social reinforcement from multiple neighbors in the social network. The behavior spread farther and faster across clustered-lattice networks than across corresponding random networks.
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            Social environment and physical activity: a review of concepts and evidence.

            The rapidly growing and evolving literature on the social environment and its influence on health outcomes currently lacks a clear taxonomy of dimensions of the social environment and the differing mechanisms through which each influences health-related behavior. This paper identifies five dimensions of the social environment-social support and social networks, socioeconomic position and income inequality, racial discrimination, social cohesion and social capital, and neighborhood factors-and considers each in the context of physical activity to illustrate important differences between them. Increasing the specificity of terminology and methods in social environmental research on health will enable more systematic inquiry and accelerate the rate of scientific discovery in this important area.
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              Effects of Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review

              Background. Community-based health workers (CBHWs) are frontline public health workers who are trusted members of the community they serve. Recently, considerable attention has been drawn to CBHWs in promoting healthy behaviors and health outcomes among vulnerable populations who often face health inequities. Objectives. We performed a systematic review to synthesize evidence concerning the types of CBHW interventions, the qualification and characteristics of CBHWs, and patient outcomes and cost-effectiveness of such interventions in vulnerable populations with chronic, noncommunicable conditions. Search methods. We undertook 4 electronic database searches—PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and Cochrane—and hand searched reference collections to identify randomized controlled trials published in English before August 2014. Selection. We screened a total of 934 unique citations initially for titles and abstracts. Two reviewers then independently evaluated 166 full-text articles that were passed onto review processes. Sixty-one studies and 6 companion articles (e.g., cost-effectiveness analysis) met eligibility criteria for inclusion. Data collection and analysis. Four trained research assistants extracted data by using a standardized data extraction form developed by the authors. Subsequently, an independent research assistant reviewed extracted data to check accuracy. Discrepancies were resolved through discussions among the study team members. Each study was evaluated for its quality by 2 research assistants who extracted relevant study information. Interrater agreement rates ranged from 61% to 91% (average 86%). Any discrepancies in terms of quality rating were resolved through team discussions. Main results. All but 4 studies were conducted in the United States. The 2 most common areas for CBHW interventions were cancer prevention (n = 30) and cardiovascular disease risk reduction (n = 26). The roles assumed by CBHWs included health education (n = 48), counseling (n = 36), navigation assistance (n = 21), case management (n = 4), social services (n = 7), and social support (n = 18). Fifty-three studies provided information regarding CBHW training, yet CBHW competency evaluation (n = 9) and supervision procedures (n = 24) were largely underreported. The length and duration of CBHW training ranged from 4 hours to 240 hours with an average of 41.3 hours (median: 16.5 hours) in 24 studies that reported length of training. Eight studies reported the frequency of supervision, which ranged from weekly to monthly. There was a trend toward improvements in cancer prevention (n = 21) and cardiovascular risk reduction (n = 16). Eight articles documented cost analyses and found that integrating CBHWs into the health care delivery system was associated with cost-effective and sustainable care. Conclusions. Interventions by CBHWs appear to be effective when compared with alternatives and also cost-effective for certain health conditions, particularly when partnering with low-income, underserved, and racial and ethnic minority communities. Future research is warranted to fully incorporate CBHWs into the health care system to promote noncommunicable health outcomes among vulnerable populations.
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                Author and article information

                Contributors
                Lh2746@cumc.columbia.edu
                mg4144@cumc.columbia.edu
                ingrid@medable.com
                jessica.watterson@monash.edu
                kate-c-magsamen@uiowa.edu
                cheryl.jones@manchester.ac.uk
                K.Gokal@lboro.ac.uk
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                7 October 2021
                7 October 2021
                2021
                : 21
                : 1805
                Affiliations
                [1 ]GRID grid.21729.3f, ISNI 0000000419368729, Department of Epidemiology, , Columbia University Mailman School of Public Health, ; 722 W 168th Street, New York, NY 10032 USA
                [2 ]GRID grid.21729.3f, ISNI 0000000419368729, Herbert Irving Comprehensive Cancer Center, ; 1130 St Nicholas Avenue, New York, NY 10032 USA
                [3 ]GRID grid.20505.32, ISNI 0000 0004 0375 6882, The Public Health Institute, The Data and Technology Proving Ground Program, ; 555 12th Ave, 10th Floor, Oakland, CA 94607 USA
                [4 ]Medable Inc, 525 University Ave, Ste A70, Palo Alto, CA 94301 USA
                [5 ]GRID grid.440425.3, Jeffrey Cheah School of Medicine and Health Sciences, , Monash University Malaysia, ; Subang Jaya, Malaysia
                [6 ]GRID grid.47840.3f, ISNI 0000 0001 2181 7878, Center for Healthcare Organizational and Innovation Research (CHOIR), School of Public Health, , University of California, Berkeley, ; 50 University Hall, Berkeley, CA 94704 USA
                [7 ]GRID grid.214572.7, ISNI 0000 0004 1936 8294, Department of Communication Studies, , The University of Iowa, ; 257 Becker Communication Studies Building, Iowa City, IA 52245 USA
                [8 ]Holden Comprehensive Care Center, 200 Hawkins Drive, Iowa City, IA 52242 USA
                [9 ]GRID grid.5379.8, ISNI 0000000121662407, Manchester Centre for Health Economics, , The University of Manchester, ; Oxford Road, Manchester, M13 9PL UK
                [10 ]GRID grid.6571.5, ISNI 0000 0004 1936 8542, National Centre for Sport and Exercise Medicine (NCSEM), School of Sport, Exercise and Health Sciences, , Loughborough University, ; Leicestershire, LE11 3TU UK
                [11 ]GRID grid.6571.5, ISNI 0000 0004 1936 8542, The Centre for Lifestyle Medicine and Behaviour, School of Sport, Exercise and Health Sciences, , Loughborough University, ; LE11 3TU Leicestershire, UK
                Author information
                http://orcid.org/0000-0002-1432-1580
                Article
                11775
                10.1186/s12889-021-11775-9
                8499394
                34620141
                25f654ee-173d-4b2e-913a-20535025874a
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 16 July 2020
                : 10 September 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000289, Cancer Research UK;
                Award ID: C64528/A28666
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2021

                Public health
                community,co-design,population health,cancer prevention,technology,wellness
                Public health
                community, co-design, population health, cancer prevention, technology, wellness

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