***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: ABSTRACT Despite four decades of global experience with community-based primary health care , the strategic details of community health worker ( CHW ) recruitment , training , compensation , and deployment remain the subject of continuing discussion and debate . Responsibilities and levels of clinical expertise also vary greatly , as well as contrasting roles of public- versus private-sector organisations as organisers of CHW effort . This paper describes a programme of implementation research in Tanzania , known as the Connect Project , which aims to guide national policies with evidence on the impact and process of deploying of paid , professional CHWs . Connect is a r and omised-controlled trial of community exposure to CHW integrated primary health-care services . A qualitative appraisal of reactions to CHW implementation of community stakeholders , frontline workers , supervisors , and local managers is review ed . Results highlight the imperative to plan and implement CHW programmes as a component of a broader , integrated effort to strengthen the health system . Specifically , the introduction of a CHW programme in Tanzania should draw upon community structures and institutions and strengthen mechanisms to sustain their participation in primary health care . This should be coordinated with efforts to address poorly functioning logistics and supervisory systems and human re source and management challenges Background The use of lay people to deliver education programmes for people with chronic conditions is a potential method of addressing healthcare staff capacity and increasing the cost efficiency of delivering education . This qualitative sub study is embedded within an equivalence trial ( 2008–2011 including development stage ) . Objectives In the qualitative sub study , we aim ed to elicit the views of key stakeholders ( patients , educators ) about using lay people to deliver education to people recently diagnosed with type 2 diabetes , alongside a healthcare professional educator with an equal role . In this way , we sought to explore perceptions about acceptability and also contribute to underst and ing the reasons underlying positive or negative quantitative findings from main trial . Methods We conducted  27 telephone interviews with a purposive sample of patients , lay educators and healthcare professional educators involved in the main trial . Thematic analysis of transcribed data was underpinned by the constant comparative approach and structured using Framework methodology . Results Overall , the data suggested that the use of lay educators was acceptable to educators and patients . Perceived difference in knowledge levels between lay and healthcare professional educators did not appear to have an impact on perceived acceptability or the effectiveness of the education received . Additional themes explored were related to peer status of educators and feasibility . Some concerns were raised about lay educators with diabetes , transferring personal issues and about the impact of healthcare professional time taken up by mentoring and supporting lay educators . Conclusions Positive perceptions about the use of lay educators support the positive quantitative findings from the main trial . Acceptability is an important consideration in relation to implementation of the model of delivery studied . Concerns raised within the interviews should be considered in the design of training for lay educators . Trial registration number IS RCT N 99350009 Background Grounded in a community-based participatory research ( CBPR ) framework , the PROUD ( Participatory Research in Ottawa : Underst and ing Drugs ) Study aims to better underst and HIV risk and prevalence among people who use drugs in Ottawa , Ontario . The purpose of this paper is to describe the establishment of the PROUD research partnership . Methods PROUD relies on peers ’ expertise stemming from their lived experience with drug use to guide all aspects of this CBPR project . A Community Advisory Committee ( CAC ) , comprised of eight people with lived experience , three allies and three ex-officio members , has been meeting since May 2012 to oversee all aspects of the project . Eleven medical students from the University of Ottawa were recruited to work alongside the committee . Training was provided on CBPR ; HIV and harm reduction ; and administering HIV point-of-care ( POC ) tests so that the CAC can play a key role in research design , data collection , analysis , and knowledge translation activities . Results From March-December 2013 , the study enrolled 858 participants who use drugs ( defined as anyone who has injected or smoked drugs other than marijuana in the last 12 months ) into a prospect i ve cohort study . Participants completed a  one-time question naire administered by a trained peer or medical student , who then administered an HIV POC test . Recruitment , interviews and testing occurred in both the fixed research site and various community setting s across Ottawa . With consent , prospect i ve follow-up will occur through linkages to health care records available through the Institute for Clinical and Evaluation Sciences . Conclusion The PROUD Study meaningfully engaged the communities of people who use drugs in Ottawa through the formation of the CAC , the training of peers as community-based research ers , and integrated KTE throughout the research project . This project successfully supported skill development across the team and empowered people with drug use experience to take on leadership roles , ensuring that this research process will promote change at the local level . The CBPR methods developed in this study provide important insights for future research projects with people who use drugs in other setting BACKGROUND Traditional research approaches frequently fail to yield representative numbers of people of color in research . Community-based participatory research ( CBPR ) may be an important strategy for partnering with and reaching population s that bear a greater burden of illness but have been historically difficult to engage . The Community Action Board , consisting of 20 East Harlem residents , leaders , and advocates , used CBPR to compare the effectiveness of various strategies in recruiting and enrolling adults with prediabetes into a peer-led , diabetes prevention intervention . METHODS The board created five recruitment strategies : recruiting through clinicians ; recruiting at large public events such as farmers markets ; organizing special local recruitment events ; recruiting at local organizations ; and recruiting through a partner-led approach , in which community partners developed and managed the recruitment efforts at their sites . RESULTS In 3 months , 555 local adults were approached ; 249 were appropriate c and i date s for further evaluation ( overweight , nonpregnant , East Harlem residents without known diabetes ) ; 179 consented and returned in a fasting state for 1/2 day of prediabetes testing ; 99 had prediabetes and enrolled in a pilot r and omized trial . The partner-led approach was highly successful , recruiting 68 % of those enrolled . This strategy was also the most efficient ; 34 % of those approached through partners were ultimately enrolled , versus 0%-17 % enrolled through the other four strategies . Participants were predominantly low-income , uninsured , undereducated , Spanish-speaking women . CONCLUSIONS This CBPR approach highlights the value of partner-led recruitment to identify , reach out to , and motivate a vulnerable population into participation in research , using techniques that may be unfamiliar to research ers but are nevertheless rigorous and effective Coalescence of culturally relevant and community-based research with traditional scientific inquiry is necessary for the translation of science into practice . One methodology that has been identified as an important missing link in achieving the goal of combining science and community practice is the community-based participatory research approach , or CBPR . To demonstrate how CBPR has been successfully blended with r and omized control trial ( RCT ) methodology , we showcase a r and omized community trial that has shown efficacy in reducing cardiovascular risk factors integrating community health workers . The purpose of this article is 2-fold . First , it describes the process of merging the CBPR approach within an RCT framework and , second , it describes lessons learned in conducting CBPR- RCT research initiatives OBJECTIVE Effective behavioral diabetes interventions for Mexican Americans are needed . Our study focused on efforts to recruit Mexican American adults for a trial testing a diabetes community health worker ( CHW ) self-management intervention . DESIGN Behavioral r and omized controlled trial , community-based participatory research approach . SETTING Chicago . PARTICIPANTS Mexican American adults with type 2 diabetes . OUTCOME MEASURES Screening and r and omization . METHODS Initial eligibility criteria included Mexican heritage , treatment with oral diabetes medication , residence in design ated zip codes , planned residence in the area for two years , and enrollment in a specific insurance plan . RESULTS Recruitment through the insurer result ed in only one r and omized participant . Eligibility criteria were relaxed and subsequent efforts included bilingual advertisements , presentations at churches and community events , postings in clinics , partnerships with community providers , and CHW outreach . Zip codes were exp and ed multiple times and insurance criteria removed . CHW outreach result ed in 53 % of r and omized participants . CONCLUSIONS Despite strong ties with the target community , culturally appropriate recruitment strategies involving community representation , and a large pool of potential participants , significant challenges were encountered in recruitment for this diabetes intervention trial . Research ers identified three key barriers to participation : study intensity and duration , lack of financial incentives , and challenges in establishing trust . For future research to be successful , investigators need to recognize these barriers , offer adequate incentives to compensate for intervention intensity , and establish strong trust through community partnerships and the incorporation of community members in the recruitment process OBJECTIVE To develop and assess the feasibility of My Care My Call , an innovative peer-led , community-based telephone intervention for individuals with chronic spinal cord injury ( SCI ) using peer health coaches . DESIGN Qualitative pilot study . SETTING General community . PARTICIPANTS Convenience sample of consumer advocates with traumatic SCI ≥1 year postinjury ( N=7 ) . INTERVENTIONS My Care My Call applies a health empowerment approach for goal - setting support , education , and referral to empower consumers in managing their preventive health needs . For feasibility testing , peer health coaches , trained in brief action planning , called participants 6 times over 3 weeks . MAIN OUTCOME MEASURES Identified focus areas were acceptability , dem and , implementation , and practicality . Participant outcome data were collected through brief after-call surveys and qualitative exit interviews . Through a custom website , peer health coaches documented call attempts , content , and feedback . Analysis applied the constant comparative method . RESULTS My Care My Call was highly feasible in each focus area for participants . Concerning acceptability , participants were highly satisfied , rating peer health coaches as very good or excellent in 80 % of calls ; felt My Care My Call was appropriate ; and would continue use . Regarding dem and , participants completed 88 % of scheduled calls ; reported that My Care My Call fills a real need ; and would recommend it . Considering implementation , peer health coaches made 119 % of expected calls , with a larger focus on compiling individualized re sources . For practicality , call duration averaged 29 minutes , with 1 hour of additional time for peer health coaches . Participant effects included feeling supported , greater confidence toward goals , and greater connection to re sources . Subsequently , several process changes enhanced peer health coach training and support through role-plays , regular support calls , and streamlined My Care My Call support material s. CONCLUSIONS After process changes , a r and omized controlled trial to evaluate My Care My Call is underway OBJECTIVE While there is growing interest in improving  patient activation in general medical health services , there are too few r and omized controlled trials in mental health setting s which show how improvement can be achieved . Using the Patient Activation Measure-13 ( PAM-13 ) , we aim ed to assess the effect of pre-treatment , peer co-led educational intervention on patient activation . Secondary outcomes included measures of patient satisfaction , well-being , mental health symptoms , motivation , and treatment participation . METHODS Patients from two community mental health centres were r and omized to a control group ( CG , n=26 ) receiving treatment as usual , or an intervention group ( IG , n=26 ) consisting of a four-hour group educational seminar ( aim ing to encourage patients to adopt an active role in their treatment ) followed by treatment as usual . RESULTS Only the IG improved on PAM-13 , at one- and four-month follow-ups . The intervention had significant effects on patient satisfaction and treatment participation , compared to CG . CONCLUSION Providing pre-treatment , peer co-led education improves patient activation in community mental health care setting s. PRACTICE IMPLICATION S The use of peers as co-educators may contribute to a different mental health care delivery , ensuring patient activation and participation in treatment . Further studies should examine peers ' needs for supervision , challenges for the services , long-term and cost-benefit effects . CLINICAL TRIALS . GOV IDENTIFIER NCT01601587 Background : Hepatitis B-linked liver cancer disproportionately affects Hmong Americans . With an incidence rate of 18.9 per 100,000 , Hmong Americans experience liver cancer at a rate that is 6 to 7 times more than that of non-Hispanic Whites . Serologic testing for the hepatitis B virus ( HBV ) is a principal means to prevent liver cancer-related deaths through earlier identification of those at risk . Methods : Academic research ers and Hmong leaders collaborated in the design , conduct , and evaluation of a 5-year r and omized controlled trial testing a lay health worker ( LHW ) intervention to promote HBV testing among 260 Hmong adults through in-home education and patient navigation .  Results : Intervention group participants were more likely to report receiving serologic testing for HBV ( 24 % vs. 10 % , P = 0.0056 ) and showed a greater mean increase in knowledge score ( 1.3 vs. 0.3 points , P = 0.0003 ) than control group participants . Multivariable modeling indicated that self-reported test receipt was associated with intervention group assignment [ OR 3.5 ; 95 % confidence interval ( CI ) 1.3–9.2 ] , improvement in knowledge score ( OR 1.3 per point ; 95 % CI 1.02–1.7 ) , female gender ( OR 5.3 ; 95 % CI 1.7–16.6 ) , and having seen a doctor in the past year at baseline ( OR 4.8 ; 95 % CI 1.3–17.6 ) . The most often cited reason for testing was a doctor 's recommendation . Conclusions : LHWs were effective in bringing about HBV screening . Doctor visits and adher 
    Output:
    
Findings suggest that there is a wide variety of peers , titles and terminology associated with peer models .