About

Stephen C. Alder, PhD, MBA, is a faculty member at the Spencer Fox Eccles School of Medicine, primarily within the Department of Family & Preventive Medicine and as an adjunct in Internal Medicine. His research focuses on optimizing health through human-centric and system-changing development, with an emphasis on engaging communities to build capacity for accessing resources needed to achieve high-quality health outcomes. He leads research on translational and implementation science aimed at improving community-based health resources and developing community capacity for public health improvement. His work includes creating community-based approaches to developing primary health resources integrated into broader health systems and serving as a consulting expert on health workforce modeling to guide strategies for developing health professionals. Alder is also involved in developing research programs that strengthen community health and foster pathways for self-reliance through economic development. His research activities are both domestic and international, with a record of extramurally funded projects conducted at local, regional, national, and global levels.

Research topics

• Medicine
• Computer Science
• Chromatography
• Immunology
• Virology
• Internal medicine
• Environmental health
• Mathematics
• Demography
• Telecommunications
• Chemistry
• Veterinary medicine
• Statistics

Selected publications

• The ‘Health-2-Go’ programme’s impact on all-cause mortality and clinic utilisation for children 5 and under: a retrospective cohort analysis of an iCCM intervention in Ghana’s Barekese Subdistrict

  BMJ Global Health · 2025-03-01 · 2 citations

  articleOpen accessSenior author

  Introduction The ‘Health-2-Go’ programme, which incorporates the integrated community case management strategy, aims to enhance healthcare access in rural Ghana by deploying trained and equipped community-based agents to manage the diagnosis and treatment of basic illness for children aged 5 and under. This study evaluates the intervention’s impact on all-cause mortality and clinical healthcare utilisation among children 5 and under in the Barekese Subdistrict in the Atwima Nwabiagya North District of the Ashanti Region of Ghana. Methods A retrospective cohort study was conducted using data from 2530 children across nine communities exposed to Health-2-Go and six comparison communities with no Health-2-Go exposure. Child mortality data were collected via a verbally administered household census, and clinical healthcare utilisation data were extracted from clinic records. We used Cox proportional hazards regression models to estimate the impact of exposure to Health-2-Go on child mortality and negative binomial regression models to assess exposure to Health-2-Go on changes in 5 and under clinic visits resulting in a malaria diagnosis. Results Exposure to Health-2-Go was significantly associated with a 67.7% reduction in the hazard of death ( HR=0.323; p=0.015; 95% CI 0.130, 0.803 ). The programme’s impact on healthcare utilisation showed a significant 83% reduction in unnecessary clinic visits for uncomplicated malaria among children 5 and under ( IRR=0.17; p=0.027; 95% CI 0.04, 0.82 ). No significant association was found between programme exposure and the expected number of clinic visits for severe malaria among children 5 and under. Conclusions The Health-2-Go programme demonstrates substantial potential in reducing child mortality and improving healthcare access in low-resource and ‘hard-to-reach’ settings in rural Ghana. Further prospective research is recommended to confirm these findings and explore the long-term sustainability of the programme.

  PublisherOA PDFDOI

• Study protocol for the development of a real-time interface showing the availability of breast and cervical cancer services in Ghana

  PLoS ONE · 2024-10-17

  articleOpen accessCorresponding

  BACKGROUND: The 5-year survival rates for breast and cervical cancers in Ghana are low in comparison to rates in developed countries. This striking disparity is attributed to numerous factors, including limited access and navigability to appropriate services. A one-time cross-sectional, hospital-based survey was performed by the University of Utah in collaboration with Ghana Health Services (GHS) and Health Facilities Regulatory Agency (HeFRA) from November, 2020 to October, 2021 so as to determine existing hospital-based breast and cervical cancer care services capacity and their geographic availability nationwide. This related information remains dynamic in nature and time. The current project employs a public-academic implementation science and research configuration to explore and develop a real-time interface (RTIF) showing the availability of breast and cervical cancer care services at hospital facilities in-country so as to anchor up-to-date data products for the government, private-sector, and patient-centric consumption. METHODS AND ANALYSIS: Multiple methods will be employed to achieve the study objectives between December 2023 to November 2024. The first three objectives shall focus on contextual, needs, and feasibility assessments guided by the domains and constructs within the updated Consolidated Framework for Implementation Research (CFIR) during coding and thematic qualitative analysis. Using purposive sampling, breast and cervical cancer care service stakeholders shall be identified for individual in-depth interviews. The fourth objective will involve creating the RTIF prototype and piloting it in the Eastern Region of Ghana. The final and fifth objective shall employ the systems usability scale (SUS) amongst ten randomly selected individual stakeholders to assess the technical functionality of the interface. A nationwide scale-up shall follow this.

  PublisherDOI

• Obesity-Preventive Behaviors and Improvements in Depression among Diverse Utah Women Receiving Coaching from Community Health Workers

  Journal of Health Care for the Poor and Underserved · 2024-02-01 · 2 citations

  articleOpen access

  OBJECTIVES: This study evaluated how high versus low-intensity community wellness coaching and health behaviors were associated with changes in depression screen results over one year. METHODS: This was an analysis of secondary data collected in a 12-month obesity-related community health worker (CHW) program for 485 Utah women of color. Depression screen (Patient Health Questionnaire-2 score ³3) and self-reported fruit/vegetable consumption and physical activity (FV/PA) were recorded quarterly. Associations between FV/PA and changes in depression screen over time were evaluated in multivariable models. RESULTS: Positive depression screen prevalence declined over 12 months (21.7% to 9.5%) with no difference between study arms. Overall, FV ³5 times/day (AOR=1.5; 95% CI 1.0-2.2), any PA (AOR=3.1; 95% CI 1.5-6.4), and muscle strengthening activities (AOR=1.13; 95% CI 1.01-1.26) were associated with improved depression screen results over time. CONCLUSION: These results indicate value in addressing and evaluating depression in obesity-related interventions in underserved communities.

  PublisherOA PDFDOI

• Sex difference in the discordance between Abbott Architect and EuroImmun serological assays

  PeerJ · 2023-07-17

  articleOpen access

  Background: This study evaluated the discordance between Abbott Architect SARS-CoV-2 IgG and EUROIMMUN SARS-COV-2 ELISA in a seroprevalence study. Methods: From June 10 to August 15, 2020, 8,246 specimens were dually evaluated by the Abbott Architect SARS-CoV-2 IgG (Abbott) and the EUROIMMUN SARS-CoV-2 ELISA (EI) assays. Sex-stratified phi correlation coefficients were calculated to evaluate the concordance between Abbott and EI assay's quantitative results. Multivariable mixed-effect logistic models were implemented to evaluate the association between assay positivity and sex on a low prevalence sample while controlling for age, race, ethnicity, diabetes, cardiovascular disease, hypertension, immunosuppressive therapy, and autoimmune disease. Results: EI positivity among males was 2.1-fold that of females; however, no significant differences in Abbott positivity were observed between sexes. At the manufacturer-recommended threshold, the phi correlation coefficient for the Abbott and EI qualitative results among females (Φ = 0.47) was 34% greater than males (Φ = 0.35). The unadjusted and fully adjusted models yielded a strong association between sex and positive EI result for the low prevalence subgroup (unadjusted OR: 2.24, CI: 1.63, 3.11, adjusted OR: 3.40, CI: 2.15, 5.39). A similar analysis of Abbott positivity in the low prevalence subgroup did not find an association with any of the covariates examined. Significant quantitative and qualitative discordance was observed between Abbott and EI throughout the seroprevalence study. Our results suggest the presence of sex-associated specificity limitations with the EI assay. As these findings may extend to other anti-S assays utilized for SARS-CoV-2 seroprevalence investigations, further investigation is needed to evaluate the generalizability of these findings.

  PublisherOA PDFDOI

• Differences in perceptions and acceptance of COVID-19 vaccination between vaccine hesitant and non-hesitant persons

  PLoS ONE · 2023-09-08 · 7 citations

  articleOpen accessCorresponding

  Acceptance of the COVID-19 vaccination becomes more critical as new variants continue to evolve and the United States (US) attempts to move from pandemic response to management and control. COVID-19 stands out in the unique way it has polarized patients and generated sustained vaccine hesitancy over time. We sought to understand differences in perceptions and acceptance of COVID-19 vaccination between vaccine hesitant and non-hesitant patients, with the goal of informing communication and implementation strategies to increase uptake of COVID-19 vaccines in Veteran and non-Veteran communities. This qualitative study used interview data from focus groups conducted by the Department of Veterans Affairs (VA) and the University of Utah; all focus groups were conducted using the same script March-July 2021. Groups included forty-six United States Veterans receiving care at 28 VA facilities across the country and 166 non-Veterans across Utah for a total of 36 one-hour focus groups. We identified perceptions and attitudes toward COVID-19 vaccination through qualitative analysis of focus group participant remarks, grouping connections with identified themes within domains developed based on the questions asked in the focus group guide. Responses suggest participant attitudes toward the COVID-19 vaccine were shaped primarily by vaccine attitude changes over time, impacted by perceived vaccine benefits, risks, differing sources of vaccine information and political ideology. Veterans appeared more polarized, being either largely non-hesitant, or hesitant, whereas non-Veterans had a wider range of hesitancy, with more participants identifying minor doubts and concerns about receiving the vaccine, or simply being altogether unsure about receiving it. Development of COVID-19 vaccine communication strategies in Veteran and non-Veteran communities should anticipate incongruous sources of information and explicitly target community differences in perceptions of risks and benefits associated with the vaccine to generate candid discussions and repair individuals' trust. We believe this could accelerate vaccine acceptance over time.

  PublisherDOI

• Examining the outcomes of the ‘Health 2 go’ project: A community health worker intervention program, 2016-2020

  International Journal of Advance Research in Community Health Nursing · 2023-07-01 · 1 citations

  articleSenior author

  Objective: The primary objective of the study is to evaluate the outcome of the ‘Health 2 Go’ Program; a community-based health intervention focusing on improving the health of children under five years in selected rural Ghanaian communities.Design: A retrospective cross-sectional study was employed. Settings: Selected hard-to-reach rural communities in the Wawase and BCCDP Sites located in the Eastern and Ashanti Regions of Ghana.Participants: Caregiver of children under five years of age diagnosed with malaria, pneumonia, and diarrhoea by Community Based Agents (CBAs) between November, 2016 and January, 2020. Results: A total of 22,332 home visits (counts of child visits made by the health worker to assess the sick child) were conducted for the period under review. Malaria was the most frequent morbidity at both sites, followed by Acute Respiratory Infections (ARI) and Diarrhoea, with most disease conditions detected between May and September and peaking in October and November. The number of referrals were also positively correlated with the number of malaria cases in children under five.Conclusion: Reported home visits by the CBAs was observed to positively correlate to case detection among children under five years. Malaria is the most frequent diagnosed morbidity among the reported diseases among children. We recommend an increase in the number of home visits conducted with volunteers heightening surveillance among children under five years during the rainy season and immediately thereafter.

  PublisherDOI

• Strategies to increase rural maternal utilization of skilled health personnel for childbirth delivery in low- and middle-income countries: a narrative review

  Global Health Action · 2022-05-04 · 7 citations

  reviewOpen accessSenior author

  BACKGROUND: Skilled attendance at birth is considered key to accomplishing Sustainable Development Goal (SDG) 3.1 aimed at reducing maternal mortality. Many maternal deaths can be prevented if a woman receives care by skilled health personnel. Maternal utilization of skilled health delivery services in rural areas in low- and middle-income countries is 70% compared to 90% in urban areas. Previous studies have found community-based interventions may increase rural maternal uptake of skilled health delivery services, but evidence is lacking on which strategies are most effective. OBJECTIVE: To review the effectiveness of community-based strategies to increase rural maternal utilization of skilled health personnel for childbirth delivery in low-and middle-income countries. METHODS: We conducted a narrative review. PubMed, CINAHL, Cochrane Library, and PsycINFO databases were searched for articles from database inception through 13 November 2019. Key search terms were pre-determined. Information was extracted on studies meeting our inclusion criteria: cluster and randomized trials, rural setting, reproductive aged women, community engagement, low- and middle-income countries. Studies were considered effective if statistically significant (p < 0.05). A narrative synthesis was conducted. RESULTS: Ten cluster randomized trials out of 5,895 candidate citations met the inclusion criteria. Strategies included home-based visits, women's groups, and combined approaches. Out of the ten articles, only three studies were found to significantly increase maternal uptake of skilled health personnel for delivery, and each used a different strategy. The results are inconclusive as to which strategies are most effective. Limitations of this review include heterogeneity and generalizability of studies. CONCLUSIONS: This research suggests that different strategies may be effective at improving maternal utilization of skilled health personnel for delivery in certain rural settings while ineffective in others. More research is warranted to better understand the context in which strategies may be effective and under what conditions.

  PublisherOA PDFDOI

• Dietary intakes, eating habits and socioeconomic determinants of childhood malnutrition among children under 5 years of age in rural Lingshui county, Hainan, China

  One Health Bulletin · 2021-01-01 · 1 citations

  articleOpen access

  Objective: To investigate the associations between dietary intakes, eating habits, socioeconomic determinants and malnutrition in children under 5 years old in south China. Method: A case-control study with 182 malnourished (case) and 254 normal (control) children was conducted in four towns using anthropometric measurements and questionnaires. Results: The dietary intakes of calory, protein, vitamin and minerals of malnourished children were lower than their normal counterparts. Overall, 37.9% children ‘monthly or never’ ate egg and egg products, 61.5% ‘monthly or never’ ate beans and soy products, but 76.7% had candies or cakes ‘daily or weekly’. Four identified determinants of malnutrition were: 1) low education level of mother ( OR 1.65; 95% CI 1.02-2.67); 2) more children in one family ( OR 1.86; 95% CI 1.14-3.03); 3) absence of independent eating habit ( OR 1.75; 95% CI 1.13-2.72); and 4) long dining time (≥20 min) ( OR 1.91; 95% CI 1.12-3.24). Conclusions: Inadequate dietary intake, lower socioeconomic status and inappropriate eating habits were the major determinants of childhood malnutrition in south China. Nutritional intervention focusing on education and behavior change are warranted to help reduce the rate of malnourishment among the children of rural families in the future.

  PublisherDOI

• High variability in transmission of SARS-CoV-2 within households and implications for control

  medRxiv · 2021-02-01 · 1 citations

  preprintOpen access

  Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a high risk of transmission in close-contact indoor settings, which may include households. Prior studies have found a wide range of household secondary attack rates and may contain biases due to simplifying assumptions about transmission variability and test accuracy. Methods We compiled serological SARS-CoV-2 antibody test data and prior SARS-CoV-2 test reporting from members of 9,224 Utah households. We paired these data with a probabilistic model of household importation and transmission. We calculated a maximum likelihood estimate of the importation probability, mean and variability of household transmission probability, and sensitivity and specificity of test data. Given our household transmission estimates, we estimated the threshold of non-household transmission required for epidemic growth in the population. Results We estimated that individuals in our study households had a 0.41% (95% CI 0.32% – 0.51%) chance of acquiring SARS-CoV-2 infection outside their household. Our household secondary attack rate estimate was 36% (27% – 48%), substantially higher than the crude estimate of 16% unadjusted for imperfect serological test specificity and other factors. We found evidence for high variability in individual transmissibility, with higher probability of no transmissions or many transmissions compared to standard models. With household transmission at our estimates, the average number of non-household transmissions per case must be kept below 0.41 (0.33 – 0.52) to avoid continued growth of the pandemic in Utah. Conclusions Our findings suggest that crude estimates of household secondary attack rate based on serology data without accounting for false positive tests may underestimate the true average transmissibility, even when test specificity is high. Our finding of potential high variability (overdispersion) in transmissibility of infected individuals is consistent with characterizing SARS-CoV-2 transmission being largely driven by superspreading from a minority of infected individuals. Mitigation efforts targeting large households and other locations where many people congregate indoors might curb continued spread of the virus.

  PublisherOA PDFDOI

• Probability-Based Estimates of Severe Acute Respiratory Syndrome Coronavirus 2 Seroprevalence and Detection Fraction, Utah, USA

  Emerging infectious diseases · 2021 · 9 citations

  Senior authorCorresponding
  • Virology
  • Medicine
  • Internal medicine

  We aimed to generate an unbiased estimate of the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in 4 urban counties in Utah, USA. We used a multistage sampling design to randomly select community-representative participants >12 years of age. During May 4-June 30, 2020, we collected serum samples and survey responses from 8,108 persons belonging to 5,125 households. We used a qualitative chemiluminescent microparticle immunoassay to detect SARS-CoV-2 IgG in serum samples. We estimated the overall seroprevalence to be 0.8%. The estimated seroprevalence-to-case count ratio was 2.5, corresponding to a detection fraction of 40%. Only 0.2% of participants from whom we collected nasopharyngeal swab samples had SARS-CoV-2-positive reverse transcription PCR results. SARS-CoV-2 antibody prevalence during the study was low, and prevalence of PCR-positive cases was even lower. The comparatively high SARS-CoV-2 detection rate (40%) demonstrates the effectiveness of Utah's testing strategy and public health response.

  PublisherOA PDFDOI

Frequent coauthors

• Matthew H. Samore

  University of Utah

  22 shared

• George L. White

  University of South Australia

  19 shared

• Joseph L. Lyon

  17 shared

• Joseph B. Stanford

  Utah Department of Health

  15 shared

• Benjamin T. Crookston

  Brigham Young University

  13 shared

• Michael K. Magill

  American Academy of Family Physicians

  13 shared

• Ty Dickerson

  University of Utah

  12 shared

• Sara E. Simonsen

  University of Utah

  11 shared