Suchergebnisse

Objective Recognition programs are designed to incentivize early care and education (ECE) settings to implement childhood obesity prevention standards, yet little is known regarding their efficacy. This scoping review details characteristics, methodologies, and criteria used to evaluate recognition programs, identifies gaps in evaluation, and synthesizes existing evidence. Data Source A public health librarian created the search strategies for six databases: Ovid MEDLINE, AGRICOLA, CAB Abstracts, PAIS Index, ERIC, and Scopus. Study Inclusion and Exclusion Criteria Inclusion criteria include recognition program, ECE setting, nutrition or physical activity, and qualitative or quantitative outcomes. Exclusion criteria include programming without recognition component, no ECE setting, no nutrition or physical activity outcome, case studies, or not written in English. Data Extraction Three researchers independently extracted and complied data into an Excel spreadsheet. Data Synthesis Tables were created describing location, recognition program criteria, award incentive, study design, study sample, risk of bias, and outcomes (e.g., menu nutrition) evaluated in each study. Results Three unique recognition programs (described in 7 studies) provided technical assistance, incentives, and training. While outcome measures and study designs varied across programs, it is clear that recognition programs are well accepted and feasible, and one study demonstrated beneficial weight outcomes. Conclusion Although additional evaluation is needed, recognition programs may be a promising strategy to improve obesity prevention practices in ECE.

AbstractIntroductionNearly 40 years into the HIV epidemic, the persistence of HIV stigma is a matter of grave urgency. Discrimination (i.e. enacted stigma) in healthcare settings is particularly problematic as it deprives people of critical healthcare services while also discouraging preventive care seeking by confirming fears of anticipated stigma. We review existing research on the effectiveness of stigma interventions in healthcare settings of low‐ and middle‐income countries (LMIC), where stigma control efforts are often further complicated by heavy HIV burdens, less developed healthcare systems, and the layering of HIV stigma with discrimination towards other marginalized identities. This review describes progress in this field to date and identifies research gaps to guide future directions for research.MethodsWe conducted a scoping review of HIV reduction interventions in LMIC healthcare settings using Embase, Ovid MEDLINE, PsycINFO and Scopus (through March 5, 2020). Information regarding study design, stigma measurement techniques, intervention features and study findings were extracted. We also assessed methodological rigor using the Joanna Briggs Institute checklist for systematic reviews.Results and discussionOur search identified 8766 studies, of which 19 were included in the final analysis. All but one study reported reductions in stigma following the intervention. The studies demonstrated broad regional distribution across LMIC and many employed designs that made use of a control condition. However, these strengths masked key shortcomings including a dearth of research from the lowest income category of LMIC and a lack of interventions to address institutional or structural determinants of stigma. Lastly, despite the fact that most stigma measures were based on existing instruments, only three studies described steps taken to validate or adapt the stigma measures to local settings.ConclusionsCombating healthcare stigma in LMIC demands interventions that can simultaneously address resource constraints, high HIV burden and more severe stigma. Our findings suggest that this will require more objective, reliable and culturally adaptable stigma measures to facilitate meaningful programme evaluation and comparison across studies. All but one study concluded that their interventions were effective in reducing healthcare stigma. Though encouraging, the fact that most studies measured impact using self‐reported measures suggests that social desirability may bias results upwards. Homogeneity of study results also hindered our ability to draw substantive conclusions about potential best practices to guide the design of future stigma reduction programmes.