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Scheffey K, Avelis J, Patel M, Oon AL, Evans C, Glanz K. Use of Community Engagement Studios to Adapt a Hybrid Effectiveness-Implementation Study of Social Incentives and Physical Activity for the STEP Together Study. Health Promot Pract 2024; 25:285-292. [PMID: 35899691 PMCID: PMC10183149 DOI: 10.1177/15248399221113863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Physical activity is known to contribute to good health, but most adults in the United States do not meet recommended physical activity guidelines. Social incentive interventions that leverage insights from behavioral economics have increased physical activity in short-term trials, but there is limited evidence of their effectiveness in community settings or their long-term effectiveness. The STEP Together study is a Hybrid Type 1 effectiveness-implementation study to address these evidence and implementation gaps. This paper describes the process of adapting study procedures prior to the effectiveness trial using Community Engagement (CE) Studios, facilitated meetings during which community members provide feedback on research projects. Six CE Studios were held with community members from the priority population. They were conducted remotely because of the COVID-19 pandemic. Fifteen liaisons representing 13 community organizations and 21 community members from different neighborhoods in Philadelphia participated. Three elements of the study design were modified based on feedback from the CE Studios: lowering the age requirement for an 'older adult', clarifying the definition of family members to include second-degree relatives, and adding a 6-month survey. These adaptations will improve the fit of the effectiveness trial to the local context and improve participant engagement and retention. CE Studios can be used to adapt intervention strategies and other aspects of study design during hybrid implementation-effectiveness trials. This approach was successfully used with remote online participation due to the COVID-19 pandemic and serves as a model for future community-engaged implementation research.
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Affiliation(s)
| | - Jade Avelis
- University of Pennsylvania, Philadelphia, PA, USA
| | - Mitesh Patel
- University of Pennsylvania, Philadelphia, PA, USA
- Ascension Health, St. Louis, MO, USA
| | - Ai Leen Oon
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Karen Glanz
- University of Pennsylvania, Philadelphia, PA, USA
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Pang PS, Berger DA, Mahler SA, Li X, Pressler SJ, Lane KA, Bischof JJ, Char D, Diercks D, Jones AE, Hess EP, Levy P, Miller JB, Venkat A, Harrison NE, Collins SP. Short-Stay Units vs Routine Admission From the Emergency Department in Patients With Acute Heart Failure: The SSU-AHF Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2350511. [PMID: 38198141 PMCID: PMC10782263 DOI: 10.1001/jamanetworkopen.2023.50511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/15/2023] [Indexed: 01/11/2024] Open
Abstract
Importance More than 80% of patients who present to the emergency department (ED) with acute heart failure (AHF) are hospitalized. With more than 1 million annual hospitalizations for AHF in the US, safe and effective alternatives are needed. Care for AHF in short-stay units (SSUs) may be safe and more efficient than hospitalization, especially for lower-risk patients, but randomized clinical trial data are lacking. Objective To compare the effectiveness of SSU care vs hospitalization in lower-risk patients with AHF. Design, Setting, and Participants This multicenter randomized clinical trial randomly assigned low-risk patients with AHF 1:1 to SSU or hospital admission from the ED. Patients received follow-up at 30 and 90 days post discharge. The study began December 6, 2017, and was completed on July 22, 2021. The data were analyzed between March 27, 2020, and November 11, 2023. Intervention Randomized post-ED disposition to less than 24 hours of SSU care vs hospitalization. Main Outcomes and Measures The study was designed to detect at least 1-day superiority for a primary outcome of days alive and out of hospital (DAOOH) at 30-day follow-up for 534 participants, with an allowance of 10% participant attrition. Due to the COVID-19 pandemic, enrollment was truncated at 194 participants. Before unmasking, the primary outcome was changed from DAOOH to an outcome with adequate statistical power: quality of life as measured by the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12). The KCCQ-12 scores range from 0 to 100, with higher scores indicating better quality of life. Results Of the 193 patients enrolled (1 was found ineligible after randomization), the mean (SD) age was 64.8 (14.8) years, 79 (40.9%) were women, and 114 (59.1%) were men. Baseline characteristics were balanced between arms. The mean (SD) KCCQ-12 summary score between the SSU and hospitalization arms at 30 days was 51.3 (25.7) vs 45.8 (23.8) points, respectively (P = .19). Participants in the SSU arm had 1.6 more DAOOH at 30-day follow-up than those in the hospitalization arm (median [IQR], 26.9 [24.4-28.8] vs 25.4 [22.0-27.7] days; P = .02). Adverse events were uncommon and similar in both arms. Conclusions and Relevance The findings show that the SSU strategy was no different than hospitalization with regard to KCCQ-12 score, superior for more DAOOH, and safe for lower-risk patients with AHF. These findings of lower health care utilization with the SSU strategy need to be definitively tested in an adequately powered study. Trial Registration ClinicalTrials.gov Identifier: NCT03302910.
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Affiliation(s)
- Peter S. Pang
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis
| | - David A. Berger
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Simon A. Mahler
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Xiaochun Li
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis
| | | | - Kathleen A. Lane
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis
| | - Jason J. Bischof
- Department of Emergency Medicine, The Ohio State University, Columbus
| | - Douglas Char
- Department of Emergency Medicine, Washington University in St Louis, St Louis, Missouri
| | - Deborah Diercks
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Alan E. Jones
- Department of Emergency Medicine, University of Mississippi Medical Center, Jackson
| | - Erik P. Hess
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Phillip Levy
- Wayne State University School of Medicine and Integrative Biosciences Center, Detroit, Michigan
| | - Joseph B. Miller
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Arvind Venkat
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Nicholas E. Harrison
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis
| | - Sean P. Collins
- Department of Emergency Medicine, Vanderbilt University School of Medicine and Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center, Nashville, Tennessee
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Taylor-Swanson L, Stoddard K, Fritz J, Anderson B(B, Cortez M, Conboy L, Sheng X, Flake N, Sanchez-Birkhead A, Stark LA, Farah L, Farah S, Lee D, Merkley H, Pacheco L, Tavake-Pasi F, Sanders W, Villalta J, Moreno C, Gardiner P. Midlife Women's Menopausal Transition Symptom Experience and Access to Medical and Integrative Health Care: Informing the Development of MENOGAP. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241268355. [PMID: 39092447 PMCID: PMC11292722 DOI: 10.1177/27536130241268355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 06/14/2024] [Accepted: 07/03/2024] [Indexed: 08/04/2024]
Abstract
Background Individuals with a uterus experience menopause, the cessation of menses, on average at age 51 years in the United States. While menopause is a natural occurrence for most, over 85% of women experience multiple interfering symptoms. Menopausal women face health disparities, including a lack of access to high-quality healthcare and greater disparities are experienced by women who are black, indigenous, and people of color. Some women are turning away from hormone therapy, and some seek integrative health interventions. Objective Some menopausal women who seek healthcare do not receive it as they lack access to medical and integrative healthcare providers. A potential solution to this problem is a medical group visit (MGV), during which a provider sees multiple patients at once. The aims of this study were to gather women's opinions about the menopause, provider access, and conventional and integrative health interventions for later use to develop a menopause MGV. Methods We conducted a Community Engagement Session and a Return of Results (RoR) with midlife women to learn about their menopause experiences, barriers and facilitators to accessing health providers, and their interest in and suggestions for designing a future integrative MGV (IMGV). Thematic qualitative research methods were used to summarize session results. Results Nine women participated in the Session and six attended the RoR. Participants were well-educated and diverse in race and ethnicity. Themes included: an interest in this topic; unfamiliar medical terms; relevant social factors; desired whole person care; interest in integrative health; barriers and facilitators to accessing healthcare. The group expressed interest in ongoing participation in the future process of adapting an IMGV, naming it MENOGAP. Conclusion These findings highlight the importance of stakeholder engagement before designing and implementing MENOGAP and the great need among midlife women for education about the menopausal transition, integrative self-care, and healthcare.
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Affiliation(s)
| | - Kari Stoddard
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Julie Fritz
- College of Health, University of Utah, Salt Lake City, UT, USA
| | | | - Melissa Cortez
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Lisa Conboy
- Instructor in Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Xiaoming Sheng
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Naomi Flake
- Utah Clinical and Translational Science Institute, University of Utah, Salt Lake City, UT, USA
| | | | - Louisa A. Stark
- Utah Clinical and Translational Science Institute, University of Utah, Salt Lake City, UT, USA
- Department of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Luul Farah
- University of Utah, Salt Lake City, UT, USA
| | - Sara Farah
- University of Utah, Salt Lake City, UT, USA
| | | | - Heather Merkley
- College of Health Professions, Weber State University, Ogden, UT, USA
| | | | | | | | | | - Camille Moreno
- School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Paula Gardiner
- University of Massachusetts Medical School and Director of Primary Care Implementation Research, Cambridge Health Alliance, Cambridge, MA, USA
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Alvarado J, Strong LL, Buzcu-Guven B, Thompson LB, Cantu E, Carrier CC, Chukwu CD, Harris CL, Melendez LK, Roberson CL, Ross AM, Russell SC, Sanchez P, Tahanan A, Zdenek BC, Reininger BM, McNeill LH. Community scientist program provides bi-directional communication and co-learning between researchers and community members. J Clin Transl Sci 2023; 8:e18. [PMID: 38384927 PMCID: PMC10879996 DOI: 10.1017/cts.2023.703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/04/2023] [Accepted: 12/15/2023] [Indexed: 02/23/2024] Open
Abstract
Community involvement in research is key to translating science into practice, and new approaches to engaging community members in research design and implementation are needed. The Community Scientist Program, established at the MD Anderson Cancer Center in Houston in 2018 and expanded to two other Texas institutions in 2021, provides researchers with rapid feedback from community members on study feasibility and design, cultural appropriateness, participant recruitment, and research implementation. This paper aims to describe the Community Scientist Program and assess Community Scientists' and researchers' satisfaction with the program. We present the analysis of the data collected from 116 Community Scientists and 64 researchers who attended 100 feedback sessions, across three regions of Texas including Northeast Texas, Houston, and Rio Grande Valley between June 2018 and December 2022. Community Scientists stated that the feedback sessions increased their knowledge and changed their perception of research. All researchers (100%) were satisfied with the feedback and reported that it influenced their current and future research methods. Our evaluation demonstrates that the key features of the Community Scientist Program such as follow-up evaluations, effective bi-directional communication, and fair compensation transform how research is conducted and contribute to reducing health disparities.
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Affiliation(s)
- Jessica Alvarado
- School of Health Professions, The University of Texas at Tyler, Tyler, TX, USA
| | - Larkin L. Strong
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Birnur Buzcu-Guven
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Leonetta B. Thompson
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erica Cantu
- UTHealth Houston School of Public Health Regional Campus at Brownsville, Brownsville, TX, USA
| | - Chelsea C. Carrier
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chiamaka D. Chukwu
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cassandra L. Harris
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Luz K. Melendez
- UTHealth Houston School of Public Health Regional Campus at Brownsville, Brownsville, TX, USA
| | - Crystal L. Roberson
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Angela M. Ross
- UTHealth Houston McWilliams School of Biomedical Informatics, Houston, TX, USA
| | - Sophia C. Russell
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pablo Sanchez
- UTHealth Houston School of Public Health Regional Campus at Brownsville, Brownsville, TX, USA
| | | | - Blair C. Zdenek
- UTHealth Houston School of Public Health Regional Campus at Brownsville, Brownsville, TX, USA
| | - Belinda M. Reininger
- UTHealth Houston School of Public Health Regional Campus at Brownsville, Brownsville, TX, USA
| | - Lorna H. McNeill
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Ramirez M, Wool J, Bishop S, Hara-Hubbard KK, Jang SH, Leong J, Hassell L, Ko LK. The community voices program to facilitate community-academic researcher partnerships: Stakeholder perspectives on the program's usefulness. J Clin Transl Sci 2023; 7:e237. [PMID: 38028353 PMCID: PMC10663767 DOI: 10.1017/cts.2023.657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/10/2023] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The Institute of Translational Health Sciences (Clinical and Translational Science Awards Program hub) developed a program coined Community Voices to invite communities to submit project ideas and be matched with academic researchers. We describe formative research to understand community and academic researcher perspectives on how the program could facilitate collaborations addressing community priorities. Methods We conducted four focus groups with 31 community-based organization (CBO) representatives and 11 semi-structured interviews with academic researchers in the Washington, Wyoming, Alaska, Montana, and Idaho regions. Questions included the appeal of Community Voices to engage community and academic partners, potential program usefulness, and Community Voices' potential role in building community-academic partnerships. We used an inductive, constant comparison approach to code transcripts and thematic analysis to generate themes. Results Most CBO representatives were female (87.1%) and Hispanic/Latino (61.3%). Most academic researchers had a PhD (63.6%) and worked at a university (81.8%). The themes were: (1) community-academic partnerships built on trust will offer mutual benefit, (2) community-initiated project ideas should prioritize community needs, (3) matchmaking will accelerate connections but should not replace time to foster partnership, (4) Community Voices should go beyond matchmaking and provide ongoing support/training, and (5) fostering effective communication is key to partnership success. Conclusions Community Voices is a novel, bidirectional community engagement program model that advances current practices of prioritizing researchers' project ideas. This community-driven program may shift the future direction of community engagement practices where prioritizing community's ideas becomes the norm of community-academic partnerships in clinical and translational science.
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Affiliation(s)
- Magaly Ramirez
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
- Institute of Translational Health Sciences, Seattle, WA, USA
| | - Jenny Wool
- Institute of Translational Health Sciences, Seattle, WA, USA
| | - Sonia Bishop
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
- Institute of Translational Health Sciences, Seattle, WA, USA
| | - KeliAnne K. Hara-Hubbard
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Sou Hyun Jang
- Department of Sociology, Korea University, Seoul, Korea
| | - Judy Leong
- VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Laurie Hassell
- Institute of Translational Health Sciences, Seattle, WA, USA
| | - Linda K. Ko
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
- Institute of Translational Health Sciences, Seattle, WA, USA
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6
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Harris PA, Dunsmore SE, Atkinson JC, Benjamin DK, Bernard GR, Dean JM, Dwyer JP, Ford DF, Selker HP, Waddy SP, Wiley KL, Wilkins CH, Cook SK, Burr JS, Edwards TL, Huvane J, Kennedy N, Lane K, Majkowski R, Nelson S, Palm ME, Stroud M, Thompson DD, Busacca L, Elkind MSV, Kimberly RP, Reilly MP, Hanley DF. Leveraging the Expertise of the CTSA Program to Increase the Impact and Efficiency of Clinical Trials. JAMA Netw Open 2023; 6:e2336470. [PMID: 37796498 PMCID: PMC10773966 DOI: 10.1001/jamanetworkopen.2023.36470] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
Importance Multicenter clinical trials play a critical role in the translational processes that enable new treatments to reach all people and improve public health. However, conducting multicenter randomized clinical trials (mRCT) presents challenges. The Trial Innovation Network (TIN), established in 2016 to partner with the Clinical and Translational Science Award (CTSA) Consortium of academic medical institutions in the implementation of mRCTs, consists of 3 Trial Innovation Centers (TICs) and 1 Recruitment Innovation Center (RIC). This unique partnership has aimed to address critical roadblocks that impede the design and conduct of mRCTs, in expectation of accelerating the translation of novel interventions to clinical practice. The TIN's challenges and achievements are described in this article, along with examples of innovative resources and processes that may serve as useful models for other clinical trial networks providing operational and recruitment support. Observations The TIN has successfully integrated more than 60 CTSA institution program hubs into a functional network for mRCT implementation and optimization. A unique support system for investigators has been created that includes the development and deployment of novel tools, operational and recruitment services, consultation models, and rapid communication pathways designed to reduce delays in trial start-up, enhance recruitment, improve engagement of diverse research participants and communities, and streamline processes that improve the quality, efficiency, and conduct of mRCTs. These resources and processes span the clinical trial spectrum and enable the TICs and RIC to serve as coordinating centers, data centers, and recruitment specialists to assist trials across the National Institutes of Health and other agencies. The TIN's impact has been demonstrated through its response to both historical operational challenges and emerging public health emergencies, including the national opioid public health crisis and the COVID-19 pandemic. Conclusions and Relevance The TIN has worked to reduce barriers to implementing mRCTs and to improve mRCT processes and operations by providing needed clinical trial infrastructure and resources to CTSA investigators. These resources have been instrumental in more quickly and efficiently translating research discoveries into beneficial patient treatments.
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Affiliation(s)
- Paul A Harris
- Vanderbilt Institute for Clinical and Translational Research, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah E Dunsmore
- National Center for Advancing Translational Sciences, Bethesda, Maryland
| | - Jane C Atkinson
- National Center for Advancing Translational Sciences, Bethesda, Maryland
| | - Daniel Kelly Benjamin
- Duke University School of Medicine, Durham, North Carolina
- Duke Clinical Research Institute, Durham, North Carolina
| | - Gordon R Bernard
- Vanderbilt Institute for Clinical and Translational Research, Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Jamie P Dwyer
- University of Utah Health, Salt Lake City
- Utah Clinical and Translational Sciences Institute, Salt Lake City
| | - Daniel F Ford
- Johns Hopkins Institute for Clinical and Translational Research, Baltimore, Maryland
| | - Harry P Selker
- Department of Medicine, Tufts University, Boston, Massachusetts
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Salina P Waddy
- National Center for Advancing Translational Sciences, Bethesda, Maryland
| | - Kenneth L Wiley
- National Center for Advancing Translational Sciences, Bethesda, Maryland
| | - Consuelo H Wilkins
- Vanderbilt Institute for Clinical and Translational Research, Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Internal Medicine, Meharry Medical College, Nashville, Tennessee
| | - Sarah K Cook
- Vanderbilt Institute for Clinical and Translational Research, Nashville, Tennessee
| | | | - Terri L Edwards
- Vanderbilt Institute for Clinical and Translational Research, Nashville, Tennessee
| | | | - Nan Kennedy
- Vanderbilt Institute for Clinical and Translational Research, Nashville, Tennessee
| | - Karen Lane
- Johns Hopkins Institute for Clinical and Translational Research, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ryan Majkowski
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah Nelson
- Vanderbilt Institute for Clinical and Translational Research, Nashville, Tennessee
| | - Marisha E Palm
- Department of Medicine, Tufts University, Boston, Massachusetts
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Mary Stroud
- Vanderbilt Institute for Clinical and Translational Research, Nashville, Tennessee
| | - Dixie D Thompson
- University of Utah Health, Salt Lake City
- Utah Clinical and Translational Sciences Institute, Salt Lake City
| | - Linda Busacca
- Irving Institute for Clinical and Translational Research, Columbia University Irving Medical Center, New York, New York
| | - Mitchell S V Elkind
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Robert P Kimberly
- Center for Clinical and Translational Science, University of Alabama at Birmingham
| | - Muredach P Reilly
- Irving Institute for Clinical and Translational Research, Columbia University Irving Medical Center, New York, New York
| | - Daniel F Hanley
- Johns Hopkins Institute for Clinical and Translational Research, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Ming DY, Wong W, Jones KA, Antonelli RC, Gujral N, Gonzales S, Rogers U, Ratliff W, Shah N, King HA. Feasibility of Implementation of a Mobile Digital Personal Health Record to Coordinate Care for Children and Youth With Special Health Care Needs in Primary Care: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e46847. [PMID: 37728977 PMCID: PMC10551780 DOI: 10.2196/46847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Electronic health record (EHR)-integrated digital personal health records (PHRs) via Fast Healthcare Interoperability Resources (FHIR) are promising digital health tools to support care coordination (CC) for children and youth with special health care needs but remain widely unadopted; as their adoption grows, mixed methods and implementation research could guide real-world implementation and evaluation. OBJECTIVE This study (1) evaluates the feasibility of an FHIR-enabled digital PHR app for CC for children and youth with special health care needs, (2) characterizes determinants of implementation, and (3) explores associations between adoption and patient- or family-reported outcomes. METHODS This nonrandomized, single-arm, prospective feasibility trial will test an FHIR-enabled digital PHR app's use among families of children and youth with special health care needs in primary care settings. Key app features are FHIR-enabled access to structured data from the child's medical record, families' abilities to longitudinally track patient- or family-centered care goals, and sharing progress toward care goals with the child's primary care provider via a clinician dashboard. We shall enroll 40 parents or caregivers of children and youth with special health care needs to use the app for 6 months. Inclusion criteria for children and youth with special health care needs are age 0-16 years; primary care at a participating site; complex needs benefiting from CC; high hospitalization risk in the next 6 months; English speaking; having requisite technology at home (internet access, Apple iOS mobile device); and an active web-based EHR patient portal account to which a parent or caregiver has full proxy access. Digital prescriptions will be used to disseminate study recruitment materials directly to eligible participants via their existing EHR patient portal accounts. We will apply an intervention mixed methods design to link quantitative and qualitative (semistructured interviews and family engagement panels with parents of children and youth with special health care needs) data and characterize implementation determinants. Two CC frameworks (Pediatric Care Coordination Framework; Patient-Centered Medical Home) and 2 evaluation frameworks (Consolidated Framework for Implementation Research; Technology Acceptance Model) provide theoretical foundations for this study. RESULTS Participant recruitment began in fall 2022, before which we identified >300 potentially eligible patients in EHR data. A family engagement panel in fall 2021 generated formative feedback from family partners. Integrated analysis of pretrial quantitative and qualitative data informed family-centered enhancements to study procedures. CONCLUSIONS Our findings will inform how to integrate an FHIR-enabled digital PHR app for children and youth with special health care needs into clinical care. Mixed methods and implementation research will help strengthen implementation in diverse clinical settings. The study is positioned to advance knowledge of how to use digital health innovations for improving care and outcomes for children and youth with special health care needs and their families. TRIAL REGISTRATION ClinicalTrials.gov NCT05513235; https://clinicaltrials.gov/study/NCT05513235. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46847.
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Affiliation(s)
- David Y Ming
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Willis Wong
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Richard C Antonelli
- Department of Pediatrics, Boston Children's Hospital, Harvard School of Medicine, Boston, MA, United States
| | - Nitin Gujral
- Innovation and Digital Health Accelerator, Boston Children's Hospital, Boston, MA, United States
| | - Sarah Gonzales
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Ursula Rogers
- AI Health, Duke University School of Medicine, Durham, NC, United States
| | - William Ratliff
- Duke Institute for Health Innovation, Duke University School of Medicine, Durham, NC, United States
| | - Nirmish Shah
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Heather A King
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veteran Affairs Health Care System, Durham, NC, United States
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8
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Abadula F, Jordan LC, LeStourgeon L, Jaser SS. Using Community Engagement Methods to Guide Study Protocol Decisions for School-Aged Children With Type 1 Diabetes. Diabetes Spectr 2023; 37:95-99. [PMID: 38385103 PMCID: PMC10877206 DOI: 10.2337/ds23-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Introduction Many challenges exist in developing multisite protocols for newly diagnosed children with type 1 diabetes. Our research team engaged community members to increase the likelihood of study success during a planning grant for a longitudinal study aimed at understanding risk and protective factors for neurocognitive function in school-aged children newly diagnosed with type 1 diabetes. Methods Two methods were used to obtain caregiver input into study protocol decisions. The first was a survey given to caregivers of children with diabetes (n = 21) about which aspects of the study protocol would make families more or less likely to participate. The second was a Community Engagement (CE) Studio to obtain recommendations from a diverse group of caregivers of children with diabetes (n = 7) on key aspects of recruitment and enrollment. Results Results from both the survey and the CE Studio indicated that caregivers were interested and willing to participate in a longitudinal study of this nature. Both methods resulted in similar preferences for the type and amount of compensation, convenient study visits, flexible scheduling options, and receipt of neurocognitive test results. Recommendations from the CE Studio included additional strategies to minimize participant burden and enhance communication around study participation. Conclusion Both the feasibility survey and the CE Studio were useful mechanisms to obtain caregiver input during the study's planning and design phase. Uniquely, the CE Studio approach offers researchers the ability to gain valuable community member input with minimal staff effort.
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Affiliation(s)
- Fayo Abadula
- Division of Pediatric Psychology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Lori C. Jordan
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Lauren LeStourgeon
- Division of Pediatric Psychology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Sarah S. Jaser
- Division of Pediatric Psychology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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Mayers SA, Cook SK, Rantala C, Israel T, Helmer T, Schorr M, Campos G, Hahn D, Pimentel P, Wynn M, Edwards TL, Stroud M, Harris PA, Wilkins CH. The RIC Recruitment & Retention Materials Toolkit - a resource for developing community-informed study materials. J Clin Transl Sci 2023; 7:e182. [PMID: 37706001 PMCID: PMC10495822 DOI: 10.1017/cts.2023.607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 09/15/2023] Open
Abstract
Clinical trials face many challenges with meeting projected enrollment and retention goals. A study's recruitment materials and messaging convey necessary key information and therefore serve as a critical first impression with potential participants. Yet study teams often lack the resources and skills needed to develop engaging, culturally tailored, and professional-looking recruitment materials. To address this gap, the Recruitment Innovation Center recently developed a Recruitment & Retention Materials Content and Design Toolkit, which offers research teams guidance, actionable tips, resources, and customizable templates for creating trial-specific study materials. This paper seeks to describe the creation and contents of this new toolkit.
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Affiliation(s)
- Stephanie A. Mayers
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah K. Cook
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Caitlin Rantala
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tiffany Israel
- Center for Emergency Care Research & Innovation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tara Helmer
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matt Schorr
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - David Hahn
- Intracell Research Group, Wake Forest, NC, USA
| | - Pamela Pimentel
- Sue and Bill Gross School of Nursing, University of California, Irvine, CA, USA
- Institute for Clinical & Translational Science, University of California, Irvine, CA, USA
| | - Mysha Wynn
- Project Momentum, Incorporated, Rocky Mount, NC, USA
| | - Terri L. Edwards
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mary Stroud
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paul A. Harris
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Consuelo H. Wilkins
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Internal Medicine, Meharry Medical College, Nashville, TN, USA
- Office of Health Equity, Vanderbilt University Medical Center, Nashville, TN, USA
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Evans CD, Nanda JP, Ouyang P, Bone L, Byiringiro S, Lacanienta C, Clark R, Weston C, Han HR, Terkowitz M, Bates-Hopkins B, Galiatsatos P, Xu AJ, Stevens S, Himmelfarb CR. Integrating community voices in the research continuum: Perspectives on a consultation service. J Clin Transl Sci 2023; 7:e177. [PMID: 37654776 PMCID: PMC10465313 DOI: 10.1017/cts.2023.600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/21/2023] [Accepted: 07/13/2023] [Indexed: 09/02/2023] Open
Abstract
The Community Research Advisory Council (C-RAC) of the Johns Hopkins Institute for Clinical and Translational Research was established in 2009 to provide community-engaged research consultation services. In 2016-2017, C-RAC members and researchers were surveyed on their consultation experiences. Survey results and a 2019 stakeholder meeting proceeding helped redesign the consultation services. Transitioning to virtual consultations during COVID-19, the redesigning involved increasing visibility, providing consultation materials in advance, expanding member training, and effective communications. An increase in consultations from 28 (2009-2017) to 114 (2020-2022) was observed. Implementing stakeholder-researcher inputs is critical to holistic and sustained community-engaged research.
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Affiliation(s)
- Crystal D. Evans
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
| | - Joy P. Nanda
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
| | - Pamela Ouyang
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lee Bone
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- The Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Samuel Byiringiro
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
- The Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Cyd Lacanienta
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
| | - Roger Clark
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
| | - Christine Weston
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hae-Ra Han
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mia Terkowitz
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
| | - Barbara Bates-Hopkins
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Panagis Galiatsatos
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ashley Jingzhi Xu
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
- The Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Sarah Stevens
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
| | - Cheryl R. Himmelfarb
- Institute for Clinical and Translational Research (ICTR), Johns Hopkins University, Baltimore, MD, USA
- Community Research Advisory Council, The Johns Hopkins ICTR, Baltimore, MD, USA
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- The Johns Hopkins University School of Nursing, Baltimore, MD, USA
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11
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Nanda JP, Clark RS, Harrison JA, Ouyang P, Lacanienta C, Himmelfarb C. Community-academic partnerships to embrace and ensure diversity, equity, and inclusion in translational science: Evidence of successful community engagement. J Clin Transl Sci 2023; 7:e188. [PMID: 37745925 PMCID: PMC10514689 DOI: 10.1017/cts.2023.601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 04/28/2023] [Accepted: 07/17/2023] [Indexed: 09/26/2023] Open
Abstract
Community-Research Advisory Councils (C-RAC) provide a unique mechanism for building sustainable community-academic partnership, fostering bidirectional understanding of complex research issues, disseminating timely research findings, and thereby improving public trust in science. Created in 2009, the Johns Hopkins C-RAC has a mission to achieve diversity, equity, and inclusion (DEI) of stakeholders across the entire research continuum. It has nurtured over a decade of partnership among community and academic stakeholders toward addressing health disparity, health equity, structural racism, and discrimination. Evidence of successful strategies to ensure DEI in partnership and lessons learned are illustrated in this special communication.
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Affiliation(s)
- Joy P. Nanda
- Community Research Advisory Council, Johns Hopkins Institute of Clinical and Translational Research, Baltimore, MD, USA
| | - Roger S. Clark
- Community Research Advisory Council, Johns Hopkins Institute of Clinical and Translational Research, Baltimore, MD, USA
| | - Jennifer Ayana Harrison
- Community Research Advisory Council, Johns Hopkins Institute of Clinical and Translational Research, Baltimore, MD, USA
| | - Pamela Ouyang
- Community Research Advisory Council, Johns Hopkins Institute of Clinical and Translational Research, Baltimore, MD, USA
- Johns Hopkins University, Baltimore, MD, USA
| | - Cyd Lacanienta
- Community Research Advisory Council, Johns Hopkins Institute of Clinical and Translational Research, Baltimore, MD, USA
- Johns Hopkins University, Baltimore, MD, USA
| | - Cheryl Himmelfarb
- Community Research Advisory Council, Johns Hopkins Institute of Clinical and Translational Research, Baltimore, MD, USA
- Johns Hopkins University, Baltimore, MD, USA
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Lemon SC, Joseph HA, Williams S, Brown C, Aytur S, Catalano K, Chacker S, Goins KV, Rudolph L, Whitehead S, Zimmerman S, Schramm PJ. Reimagining the Role of Health Departments and Their Partners in Addressing Climate Change: Revising the Building Resilience against Climate Effects (BRACE) Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6447. [PMID: 37568988 PMCID: PMC10419192 DOI: 10.3390/ijerph20156447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/07/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023]
Abstract
Public health departments have important roles to play in addressing the local health impacts of climate change, yet are often not well prepared to do so. The Climate and Health Program (CHP) at the Centers for Disease Control and Prevention (CDC) created the Building Resilience Against Climate Effects (BRACE) framework in 2012 as a five-step planning framework to support public health departments and their partners to respond to the health impacts of climate change. CHP has initiated a process to revise the framework to address learnings from a decade of experience with BRACE and advances in the science and practice of addressing climate and health. The aim of this manuscript is to describe the methodology for revising the BRACE framework and the expected outputs of this process. Development of the revised framework and associated guidance and tools will be guided by a multi-sector expert panel, and finalization will be informed by usability testing. Planned revisions to BRACE will (1) be consistent with the vision of Public Health 3.0 and position health departments as "chief health strategists" in their communities, who are responsible for facilitating the establishment and maintenance of cross-sector collaborations with community organizations, other partners, and other government agencies to address local climate impacts and prevent further harm to historically underserved communities; (2) place health equity as a central, guiding tenet; (3) incorporate greenhouse gas mitigation strategies, in addition to its previous focus on climate adaptation; and (4) feature a new set of tools to support BRACE implementation among a diverse set of users. The revised BRACE framework and the associated tools will support public health departments and their partners as they strive to prevent and reduce the negative health impacts of climate change for everyone, while focusing on improving health equity.
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Affiliation(s)
- Stephenie C. Lemon
- Prevention Research Center, UMass Chan Medical School, Worcester, MA 01655, USA;
| | - Heather A. Joseph
- Climate and Health Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (H.A.J.); (S.W.); (C.B.); (P.J.S.)
| | - Samantha Williams
- Climate and Health Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (H.A.J.); (S.W.); (C.B.); (P.J.S.)
| | - Claudia Brown
- Climate and Health Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (H.A.J.); (S.W.); (C.B.); (P.J.S.)
| | - Semra Aytur
- Department of Health Management and Policy, College of Health and Human Services, University of New Hampshire, Durham, NH 03824, USA;
| | - Katherine Catalano
- Center for Climate, Health and Equity, American Public Health Association, Washington, DC 20001, USA;
| | | | - Karin V. Goins
- Prevention Research Center, UMass Chan Medical School, Worcester, MA 01655, USA;
| | - Linda Rudolph
- Center for Climate Change and Health, Public Health Institute, Oakland, CA 94607, USA;
| | - Sandra Whitehead
- College of Professional Studies, Sustainable Urban Planning Program, The George Washington University, Washington, DC 20052, USA;
| | | | - Paul J. Schramm
- Climate and Health Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (H.A.J.); (S.W.); (C.B.); (P.J.S.)
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Eder M(M. Aligning clinical research ethics with community-engaged and participatory research in the United States. Front Public Health 2023; 11:1122479. [PMID: 37213625 PMCID: PMC10192870 DOI: 10.3389/fpubh.2023.1122479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/14/2023] [Indexed: 05/23/2023] Open
Abstract
The professional role in ethical review of research in which boards review proposed research involving human beings continues to evolve. The scholarly literature on institutional review boards in academic centers of the United States, at which a majority of the community engaged and participatory research emanates and is reviewed, suggests the need to implement changes in board education, the infrastructure supporting review, and the accountability of review. The recommendations for change advanced in this perspective involve enhancing reviewer knowledge of local community contexts and developing an infrastructure that supports engagement in and dialogue among individuals involved in community-academic research to inform ethical review and the assessment of review outcomes. Additionally, recommendations regarding putting an institutional infrastructure in place are advanced in order to sustain community engaged and participatory research. The infrastructure can also support the collection and review of outcome data as the foundation of accountability. The recommendations outlined intend to improve clinical research ethics reviews of community-engaged and participatory research.
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Affiliation(s)
- Milton (Mickey) Eder
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, United States
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14
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Wallace AS, Wang CY, Flake N, Bristol AA, Altizer R. Feasibility and usefulness of the going home toolkit, an mhealth app, during hospital discharge: patient and clinician perspectives. Inform Health Soc Care 2023; 48:1-12. [PMID: 35234556 DOI: 10.1080/17538157.2022.2043330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Feasibility and Usefulness of the Going Home Toolkit, an mHealth App, during Hospital Discharge: Patient and Clinician Perspectives. Objective Communication gaps during discharge planning contribute to post-discharge outcomes. mHealth Apps may allow health systems to provide resources to fill patients' needs. The study's purpose was to elicit feedback regarding The Going Home Toolkit (GHT), an App that aims to facilitate patient communication about discharge needs. Participants Twenty patients hospitalized within the past year, and seven case managers involved in discharge processes from an academic health sciences center. Methods Using tablets installed with the GHT prototype, remote engagement studio interviews were used to observe GHT use and perceptions about usefulness and feasibility. Results Patients successfully used the GHT to identify resources that they may not have known otherwise. Clinicians reported the GHT would support patient engagement during discharge. However, patients liked being able to search for resources, while clinicians focused on offering a list of information. This can be described as a pull vs. push approach to accessing resources. Participants recognized the GHT's unique focus on cognitive processes related to self-management vs. knowledge transfer. Conclusions The GHT represents a valuable tool for facilitating anticipatory planning and procurement of resources post-discharge. Future work should focus on refining the user interface and user experience of the app and creating seamless links to community resources.
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Affiliation(s)
- Andrea S Wallace
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Ching-Yu Wang
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Naomi Flake
- Community Collaboration and Engagement Team, University of Utah, Salt Lake City, Utah, USA
| | - Alycia A Bristol
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Roger Altizer
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
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Currier J, Arteaga I, Turner-Uaandja H, Starling B, Pashayan N, Jäderholm C, Ponce Campuzano C, Shannon J. Represent: A community engagement roadmap to improve participant representation in cancer early detection research: An Oregon case study. Front Public Health 2023; 11:1110543. [PMID: 36935656 PMCID: PMC10020373 DOI: 10.3389/fpubh.2023.1110543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/30/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction While authentic and sustained community involvement in the research process is critically important to making new technologies and interventions effective and socially acceptable, there is uneven participation across sociodemographic, racial, and ethnic communities in many research areas, including cancer early detection research. Currently, 18% of cancer in the United States impacts Hispanics and Latinos, this population accounts for < 10% of research participants. Understanding barriers and facilitators to cancer early detection research is imperative to the ultimate success of this research. Therefore, the objectives of this study were to: understand Hispanic and Latino community perspectives in participation in cancer early detection research; and identify sustainable and mutually beneficial approaches to community engagement and involvement. Methods The Oregon Case Study, led by Oregon Health & Science University's Community Outreach, Research and Engagement (CORE) in partnership with colleagues at Vocal, a partnership between Manchester University NHS Foundation Trust and the University of Manchester and Cambridge University, adopted a participatory research approach to better understand participation in cancer early detection research from the perspectives of Oregon's Hispanic and Latino community members. We implemented two evidence-based community engagement models, the Community Engagement Studio and the Community Readiness Assessment Model. Using a facilitated format prescribed by each community engagement model, community members helped us to answer two research questions: (1) What methods help us increase participation of underrepresented communities in cancer early detection research?; and (2) How can we build trust between researchers and underrepresented communities within cancer early detection research? Quantitative (i.e., descriptive statistic) and qualitative (i.e., thematic analysis) analytic methods were used to measure and assess community knowledge, leadership, beliefs, and resources regarding participation in cancer early detection research. Results A total of 36 Hispanic and Latino community members participated in the two community engagement models. We identified three emergent themes pertaining to participation in cancer early detection research that include: low-level awareness of cancer early detection research and opportunities for research participation, structural barriers to research participation, and uncertainty of the benefits of research participation. Conclusion Our approach, using two evidence-based community engagement models, yielded valuable insights about perceptions of research participation for Hispanic and Latino community members. These findings, synthesized into three key themes, led to actionable recommendations to increase research participation.
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Affiliation(s)
- Jessica Currier
- Division of Oncological Sciences, Oregon Health and Science University, Portland, OR, United States
| | | | - Hannah Turner-Uaandja
- Vocal, Research & Innovation, Manchester University NHS Foundation Trust, in Partnership With University of Manchester, Manchester, United Kingdom
| | - Bella Starling
- Vocal, Research & Innovation, Manchester University NHS Foundation Trust, in Partnership With University of Manchester, Manchester, United Kingdom
| | - Nora Pashayan
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Christina Jäderholm
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, United States
| | | | - Jackilen Shannon
- Division of Oncological Sciences, Oregon Health and Science University, Portland, OR, United States
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Cope EL, McTigue KM, Forrest CB, Carton TW, Fair AM, Goytia C, Harrington JM, Lowe S, Merritt JG, Shenkman EA, Stephens WJ, Templeton A, Williams NA, Zemon N, Millender S, Angove RSM. Stakeholder engagement infrastructure to support multicenter research networks: Advances from the clinical research networks participating in PCORnet. Learn Health Syst 2023; 7:e10313. [PMID: 36654809 PMCID: PMC9835038 DOI: 10.1002/lrh2.10313] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 01/21/2023] Open
Abstract
Background The evidence based on the inclusion of patients and other stakeholders as partners in the clinical research process has grown substantially. However, little has been reported on how stakeholders are engaged in the governance of large-scale clinical research networks and the infrastructure used by research networks to support engagement in network-affiliated activities. Objectives The objective was to document engagement activities and practices emerging from Clinical Research Networks (CRNs) participating in PCORnet, the National Patient-Centered Clinical Research Network, specifically regarding governance and engagement infrastructure. Methods We conducted an environmental scan of PCORnet CRN engagement structures, assets, and services, focusing on network oversight structures for policy development and strategic decision-making. The scan included assets and services for supporting patient/stakeholder engagement. Data were collected by searching web-based literature and tool repositories, review of CRN Engagement Plans, analysis of previously collected key informant interviews, and CRN-based iterative review of structured worksheets. Results We identified 87 discrete engagement structures, assets, and services across nine CRNs. All CRNs engage patients/stakeholders in their governance, maintain workgroups and/or staff dedicated to overseeing engagement strategies, and offer one or more services to non-CRN researchers to enhance conducting engaged clinical research. Conclusions This work provides an important resource for the research community to explore engagement across peers, reflect on progress, consider opportunities to leverage existing infrastructure, and identify new collaborators. It also serves to highlight PCORnet as a resource for non-CRN researchers seeking to efficiently conduct engaged clinical research and a venue for advancing the science of engagement.
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Affiliation(s)
| | | | - Christopher B. Forrest
- Applied Clinical Research Center, Children's Hospital of PhiladelphiaPhiladelphiaPennsylvaniaUSA
| | | | - Alecia M. Fair
- Meharry‐Vanderbilt Alliance, Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Crispin Goytia
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount SinaiInstitute for Health Equity ResearchNew YorkNew YorkUSA
| | | | - Susan Lowe
- ADVANCE Clinical Research Network, OCHIN, Inc.PortlandOregonUSA
| | | | - Elizabeth A. Shenkman
- Department of Health Outcomes and Biomedical InformaticsCollege of Medicine, University of FloridaGainesvilleFloridaUSA
| | | | | | | | - Nadine Zemon
- OneFlorida Clinical Research Consortium, Clinical and Translational Science Institute, University of FloridaGainesvilleFloridaUSA
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Ntihirageza J, Luedke TJ, Barcelo H, Glenn J, Sanchez Ramirez E, Siegal LD, McKoy J, Kholamian A, Martinez M, Chukwudozie IB, Watson KS, Warnecke RB, Simon MA, Fitzgibbon M, Giachello AL. Community-Driven Conversations: Partnership Building through CHEC-Ins. Prog Community Health Partnersh 2023; 17:99-108. [PMID: 37462579 PMCID: PMC11338318 DOI: 10.1353/cpr.2023.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Chicago's systemically underserved communities have disproportionately high cancer rates. The Chicago Cancer Health Equity Collaborative (ChicagoCHEC) brings together academic and community partners to address these health inequities. The community conversations known as "CHEC-Ins" provide a space for community members to voice their experiences and needs and for ChicagoCHEC to fulfill its commitment to advancing health equity through collaboration and action. OBJECTIVE This paper presents a community-generated approach to social networking about cancer health issues known as CHEC-Ins. Through this innovative approach, community members and organizations share cancer related information and experiences, as well as needs and concerns, which are then channeled to ChicagoCHEC academic and administrative members who incorporate them into outreach and research activities. In this way, community members set the agenda and the process and collect the information they deem relevant and important. This paper describes the process of organizing and conducting two pilot CHEC-Ins and the model of this approach, which we intend to employ moving forward to advance partnership building and collaborative research practice between academic institutions and community partners and organizations. This paper contributes a unique model of community-generated and led outreach as a cornerstone of the ChicagoCHEC approach to community engagement. METHODS The leaders of the ChicagoCHEC Community Steering Committee spearheaded the design and implementation of CHEC-Ins, including developing the question guide and hosting events within their organizations. LESSONS LEARNED CHEC-Ins proved to be a valuable strategy for defining the role of community partners and establishing the basis for a bi-directional flow of information, resources, and productive action. The two pilot CHEC-Ins revealed important insights related to sources of cancer information, meanings and associated attitudes, barriers to access and use of health services, and social support systems in the communities where ChicagoCHEC works. We will implement this approach and continue to refine it as we conduct CHECIns moving forward.
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Shahid A, Lalani IN, Rosgen BK, Sept BG, Longmore S, Parsons Leigh J, Stelfox HT, Fiest KM. A scoping review of methods to measure and evaluate citizen engagement in health research. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:72. [PMID: 36496455 PMCID: PMC9737710 DOI: 10.1186/s40900-022-00405-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 11/29/2022] [Indexed: 05/20/2023]
Abstract
BACKGROUND Citizen engagement, or partnering with interested members of the public in health research, is becoming more common. While ongoing assessment of citizen engagement practices is considered important to its success, there is little clarity around aspects of citizen engagement that are important to assess (i.e., what to look for) and methods to assess (i.e., how to measure and/ or evaluate) citizen engagement in health research. METHODS In this scoping review, we included peer-reviewed literature that focused primarily on method(s) to measure and/or evaluate citizen engagement in health research. Independently and in duplicate, we completed title and abstract screening and full-text screening and extracted data including document characteristics, citizen engagement definitions and goals, and methods to measure or evaluate citizen engagement (including characteristics of these methods). RESULTS Our search yielded 16,762 records of which 33 records (31 peer-reviewed articles, one government report, one conference proceeding) met our inclusion criteria. Studies discussed engaging citizens (i.e., patients [n = 16], members of the public [n = 7], service users/consumers [n = 4], individuals from specific disease groups [n = 3]) in research processes. Reported methods of citizen engagement measurement and evaluation included frameworks, discussion-based methods (i.e., focus groups, interviews), survey-based methods (e.g., audits, questionnaires), and other methods (e.g., observation, prioritization tasks). Methods to measure and evaluate citizen engagement commonly focused on collecting perceptions of citizens and researchers on aspects of citizen engagement including empowerment, impact, respect, support, and value. DISCUSSION AND CONCLUSION We found that methods to measure and/or evaluate citizen engagement in health research vary widely but share some similarities in aspect of citizen engagement considered important to measure or evaluate. These aspects could be used to devise a more standardized, modifiable, and widely applicable framework for measuring and evaluating citizen engagement in research. PATIENT OR PUBLIC CONTRIBUTION Two citizen team members were involved as equal partners in study design and interpretation of its findings. SYSTEMATIC REVIEW REGISTRATION Open Science Framework (10.17605/OSF.IO/HZCBR).
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Affiliation(s)
- Anmol Shahid
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Inara N Lalani
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Brianna K Rosgen
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Science and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Bonnie G Sept
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Shelly Longmore
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jeanna Parsons Leigh
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Dalhousie University, Halifax, NS, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Community Health Science and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Alberta Health Services, Calgary, AB, Canada.
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Science and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Buse CG, Allison S, Cole DC, Fumerton R, Parkes MW, Woollard RF. Patient- and Community-Oriented Primary Care Approaches for Health in Rural, Remote and Resource-Dependent Places: Insights for Eco-Social Praxis. Front Public Health 2022; 10:867397. [PMID: 35692331 PMCID: PMC9178183 DOI: 10.3389/fpubh.2022.867397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
Accelerating ecological and societal changes require re-imagining the role of primary care and public health to address eco-social concerns in rural and remote places. In this narrative review, we searched literatures on: community-oriented primary care, patient-oriented research engagement, public health and primary care synergies, and primary care addressing social determinants of health. Our analysis was guided by questions oriented to utility for addressing concerns of social-ecological systems in rural, remote contexts characterized by a high degree of reliance on resource extraction and development (e.g., forestry, mining, oil and gas, fisheries, agriculture, ranching and/or renewables). We describe a range of useful frameworks, processes and tools that are oriented toward bolstering the resilience and engagement of both primary care and public health, though few explicitly incorporated considerations of eco-social approaches to health or broader eco-social context(s). In synthesizing the existing evidence base for integration between primary care and public health, the results signal that for community-oriented primary care and related frameworks to be useful in rural and remote community settings, practitioners are required to grapple with complexity, durable relationships, sustainable resources, holistic approaches to clinician training, Indigenous perspectives, and governance.
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Affiliation(s)
- Chris G. Buse
- Centre for Environmental Assessment Research, University of British Columbia (Okanagan Campus), Kelowna, BC, Canada
- *Correspondence: Chris G. Buse
| | | | - Donald C. Cole
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Margot Winifred Parkes
- School of Health Sciences, University of Northern British Columbia, Prince George, BC, Canada
| | - Robert F. Woollard
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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20
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Duea SR, Zimmerman EB, Vaughn LM, Dias S, Harris J. A Guide to Selecting Participatory Research Methods Based on Project and Partnership Goals. JOURNAL OF PARTICIPATORY RESEARCH METHODS 2022; 3:10.35844/001c.32605. [PMID: 35799626 PMCID: PMC9258244 DOI: 10.35844/001c.32605] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Participatory research engages community stakeholders in the research process, from problem identification and developing the research question, to dissemination of results. There is increasing recognition in the field of health research that community-engaged methods can be used throughout the research process. The volume of guidance for engaging communities and conducting participatory research has grown steadily in the past 40+ years, in many countries and contexts. Further, some institutions now require stakeholder engagement in research as a condition of funding. Interest in collaborating in the research process is also growing among patients and the public. This article provides an overview for selecting participatory research methods based on project and partnerships goals.
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Affiliation(s)
| | - Emily B. Zimmerman
- Department of Family Medicine and Population Health, Division of Epidemiology, VCU Center on Society and Health, Virginia Commonwealth University
| | - Lisa M. Vaughn
- College of Medicine, Cincinnati Children’s Hospital Medical Center/University of Cincinnati
| | - Sónia Dias
- Public Health Research Center, NOVA National School of Public Health
| | - Janet Harris
- School of Health & Related Research, University of Sheffield
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21
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Quinn ED, Cotter K, Kurin K, Brown K. Conducting a Community Engagement Studio to Adapt Enhanced Milieu Teaching. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1095-1113. [PMID: 35007426 PMCID: PMC9567404 DOI: 10.1044/2021_ajslp-21-00100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/11/2021] [Accepted: 09/25/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE Barriers to implementing evidence-based practices occur at various levels. Stakeholder input is required to identify challenges specific to clinical practice settings, client populations, and service delivery approaches. The purpose of this project was to solicit feedback from stakeholders on the telepractice service delivery and implementation strategies proposed for a future study of enhanced milieu teaching (EMT) in rural counties. METHOD A Community Engagement Studio was conducted with 11 caregivers of children with language delays living in rural counties. Caregivers and the researchers discussed early intervention service delivery for children with language delays in rural Oregon and the proposed telepractice EMT procedures. Researchers gathered feedback on three intervention components: session frequency and schedule, implementation strategies to encourage caregivers' use of EMT, and performance feedback techniques to teach caregivers. RESULTS Findings from the Community Engagement Studio led to four primary modifications to the telepractice EMT study protocol. The principal investigator increased available days and times for intervention sessions and added text-message reminders for parents. A survey was also added for caregivers to identify their preferences for additional implementation strategies (e.g., tip sheets, checklist, e-mailed session summaries) and graphic representations of performance feedback (e.g., bar graph, radial graph, mountain climber infographic). CONCLUSION Community Engagement Studios are a promising method for increasing community engagement in clinical research and soliciting stakeholder feedback on evidence-based intervention adaptations. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.17774819.
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Affiliation(s)
- Emily D. Quinn
- Institute on Development and Disability, Department of Pediatrics, Oregon Health & Science University, Portland
| | - Kathleen Cotter
- Institute on Development and Disability, Department of Pediatrics, Oregon Health & Science University, Portland
| | - Kim Kurin
- Institute on Development and Disability, Department of Pediatrics, Oregon Health & Science University, Portland
| | - Kim Brown
- Community Outreach, Research, and Engagement, Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland
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22
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O'Daniel JM, Ackerman S, Desrosiers LR, Rego S, Knight SJ, Mollison L, Byfield G, Anderson KP, Danila MI, Horowitz CR, Joseph G, Lamoure G, Lindberg NM, McMullen CK, Mittendorf KF, Ramos MA, Robinson M, Sillari C, Madden EB. Integration of stakeholder engagement from development to dissemination in genomic medicine research: Approaches and outcomes from the CSER Consortium. Genet Med 2022; 24:1108-1119. [PMID: 35227608 PMCID: PMC9081226 DOI: 10.1016/j.gim.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/07/2022] [Accepted: 01/13/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE There is a critical need for genomic medicine research that reflects and benefits socioeconomically and ancestrally diverse populations. However, disparities in research populations persist, highlighting that traditional study designs and materials may be insufficient or inaccessible to all groups. New approaches can be gained through collaborations with patient/community stakeholders. Although some benefits of stakeholder engagement are recognized, routine incorporation into the design and implementation of genomics research has yet to be realized. METHODS The National Institutes of Health-funded Clinical Sequencing Evidence-Generating Research (CSER) consortium required stakeholder engagement as a dedicated project component. Each CSER project planned and carried out stakeholder engagement activities with differing goals and expected outcomes. Examples were curated from each project to highlight engagement strategies and outcomes throughout the research lifecycle from development through dissemination. RESULTS Projects tailored strategies to individual study needs, logistical constraints, and other challenges. Lessons learned include starting early with engagement efforts across project stakeholder groups and planned flexibility to enable adaptations throughout the project lifecycle. CONCLUSION Each CSER project used more than 1 approach to engage with relevant stakeholders, resulting in numerous adaptations and tremendous value added throughout the full research lifecycle. Incorporation of community stakeholder insight improves the outcomes and relevance of genomic medicine research.
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Affiliation(s)
- Julianne M O'Daniel
- Department of Genetics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Sara Ackerman
- Department of Social & Behavioral Sciences, School of Nursing, University of California San Francisco, San Francisco, CA
| | - Lauren R Desrosiers
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Cancer Center, Texas Children's Hospital, Houston, TX
| | - Shannon Rego
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA
| | - Sara J Knight
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Lonna Mollison
- Department of Genetics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Grace Byfield
- Department of Genetics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Maria I Danila
- Division of Clinical Immunology and Rheumatology, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Carol R Horowitz
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Galen Joseph
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA
| | - Grace Lamoure
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Nangel M Lindberg
- Center for Health Research Kaiser Permanente Northwest, Portland, OR
| | - Carmit K McMullen
- Center for Health Research Kaiser Permanente Northwest, Portland, OR
| | - Kathleen F Mittendorf
- Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Michelle A Ramos
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Catherine Sillari
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Ebony B Madden
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
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Utilizing Community Engagement Studios to Inform Clinical Trial Design at a Center of Excellence for Alzheimer’s Disease. J Clin Transl Sci 2022; 6:e73. [PMID: 35836788 PMCID: PMC9257777 DOI: 10.1017/cts.2022.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 03/21/2022] [Accepted: 04/04/2022] [Indexed: 11/22/2022] Open
Abstract
Despite the disproportionate burden of Alzheimer’s disease in older adults of color, the scientific community continues to grapple with underrepresentation of racial and ethnic minorities in clinical research. Our Center of Excellence for Alzheimer’s Disease (CEAD) collaborated with a local community partner to conduct community engagement (CE) studios to effectively involve our community of diverse older adults in the early planning stages of a clinical trial. Given the COVID-19 pandemic, the in-person studio format was adapted to allow for virtual, real-time participation. Our objective is to describe the process and feasibility of conducting virtual CE studios in an older adult population. Ninety percent of participants were non-Hispanic Black community-dwelling woman aged 60 years and older. The overall background and proposed clinical trial design was presented to the participants who then made recommendations regarding potential recruitment strategies, the use of culturally relevant language to describe the study, and logistical recommendations to improve participation and retention among community members. Our CEAD successfully conducted virtual CE studios during the COVID-19 pandemic, by partnering with a community-based organization, to engage community stakeholders about clinical trial design. CEADs are in a unique position to implement CE studios to better support patient access to clinical trials.
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24
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What we wish every investigator knew - Top 4 recruitment and retention recommendations from the Recruitment Innovation Center. J Clin Transl Sci 2022. [DOI: 10.1017/cts.2022.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Zisman-Ilani Y, Buell J, Mazel S, Hennig S, Nicholson J. Virtual Community Engagement Studio (V-CES): Engaging Mothers With Mental Health and Substance Use Conditions in Research. Front Psychiatry 2022; 13:805781. [PMID: 35782439 PMCID: PMC9240264 DOI: 10.3389/fpsyt.2022.805781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
Active engagement of community stakeholders is increasingly encouraged in behavioral health research, often described as a co-production approach. Community stakeholders (e.g., patients, providers, policy makers, advocates) play a leading role together with research investigators in conducting the various phases of research, including conceptualization, design, implementation, and the interpretation and dissemination of findings. The concept of co-production has promising benefits for both the target population and the research outcomes, such as producing person-centered interventions with greater acceptability and usability potential. However, it is often the case that neither researchers nor community members are trained or skilled in co-production methods. The field of behavioral health research lacks tools and methods to guide and promote the engagement of diverse stakeholders in the research process. The purpose of this methods paper is to describe the Virtual Community Engagement Studio (V-CES) as a new method for engaging vulnerable populations like mothers with mental health and substance use conditions in research. We piloted the method in collaboration with the Maternal Mental Health Research Collaborative (MMHRC), focusing on one of the most vulnerable, under-researched populations, mothers coping with mental health and/or substance abuse disorders. Our pilot included mothers and providers who work with them as Community Experts to inform all phases of research design and implementation, and the interpretation and application of findings. The aim of this article is to describe the V-CES as a powerful tool that supports the engagement of mothers with mental health and/or substance use disorders and other community stakeholders in research, to provide examples of its use, and to make recommendations for future use, based on lessons learned. The V-CES toolkit is available for use with this target population as well as others.
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Affiliation(s)
- Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States.,Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Jennifer Buell
- Institute for Behavioral Health Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Shayna Mazel
- Institute for Behavioral Health Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Shannon Hennig
- Maternal Mental Health Research Collaborative, Calgary, AB, Canada
| | - Joanne Nicholson
- Institute for Behavioral Health Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
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Wallace AS, Luther BL, Sisler SM, Wong B, Guo JW. Integrating social determinants of health screening and referral during routine emergency department care: evaluation of reach and implementation challenges. Implement Sci Commun 2021; 2:114. [PMID: 34620248 PMCID: PMC8499465 DOI: 10.1186/s43058-021-00212-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 09/06/2021] [Indexed: 12/29/2022] Open
Abstract
Background Despite the importance of social determinants in health outcomes, little is known about the best practices for screening and referral during clinical encounters. This study aimed to implement universal social needs screening and community service referrals in an academic emergency department (ED), evaluating for feasibility, reach, and stakeholder perspectives. Methods Between January 2019 and February 2020, ED registration staff screened patients for social needs using a 10-item, low-literacy, English-Spanish screener on touchscreens that generated automatic referrals to community service outreach specialists and data linkages. The RE-AIM framework, specifically the constructs of reach and adoption, guided the evaluation. Reach was estimated through a number of approaches, completed screenings, and receipt of community service referrals. Adoption was addressed qualitatively via content analysis and qualitative coding techniques from (1) meetings, clinical interactions, and semi-structured interviews with ED staff and (2) an iterative “engagement studio” with an advisory group composed of ED patients representing diverse communities. Results Overall, 4608 participants were approached, and 61% completed the screener. The most common reason for non-completion was patient refusal (43%). Forty-seven percent of patients with completed screeners communicated one or more needs, 34% of whom agreed to follow-up by resource specialists. Of the 482 participants referred, 20% were reached by outreach specialists and referred to community agencies. Only 7% of patients completed the full process from screening to community service referral; older, male, non-White, and Hispanic patients were more likely to complete the referral process. Iterative staff (n = 8) observations and interviews demonstrated that, despite instruction for universal screening, patient presentation (e.g., appearance, insurance status) drove screening decisions. The staff communicated discomfort with, and questioned the usefulness of, screening. Patients (n = 10) communicated a desire for improved understanding of their unmet needs, but had concerns about stigmatization and privacy, and communicated how receptivity of screenings and outreach are influenced by the perceived sincerity of screening staff. Conclusions Despite the limited time and technical barriers, few patients with social needs ultimately received service referrals. Perspectives of staff and patients suggest that social needs screening during clinical encounters should incorporate structure for facilitating patient-staff relatedness and competence, and address patient vulnerability by ensuring universal, private screenings with clear intent. Trial registration ClinicalTrials.gov, NCT04630041. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00212-y.
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Affiliation(s)
- Andrea S Wallace
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112-5880, USA. .,Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, USA.
| | - Brenda L Luther
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112-5880, USA
| | - Shawna M Sisler
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112-5880, USA
| | - Bob Wong
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112-5880, USA
| | - Jia-Wen Guo
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112-5880, USA
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Options for Meaningful Engagement in Clinical Research for Busy Frontline Clinicians. J Gen Intern Med 2021; 36:2100-2104. [PMID: 33528778 PMCID: PMC8298624 DOI: 10.1007/s11606-020-06587-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
In order for health care innovations to be effective and actionable, they must align with the needs and practice patterns of those delivering care at the bedside. While research has started to incorporate the patient voice, it has yet to fully invest in the expertise of frontline clinicians. Frontline clinicians carry a wealth of clinical knowledge and the lived experience of providing real-world medical care that the research community seeks to improve. We consider options for clinicians as research stakeholders along a continuum of engagement as outlined by the UCSF Clinical and Translational Science Institute from minimal to supportive to participatory. In order to make an effective value proposition to support reallocation of clinician time to research engagement, we advocate evaluating the impact of clinicians as stakeholders at both the process level (e.g., clinician satisfaction, study recruitment rates) and endpoint level (e.g., clinical outcomes). Investing in clinicians as research stakeholders can offer benefits for the individual, health system, and population by increasing the generalizability, adoption, and sustainability of effective interventions.
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Danila MI, Allison JJ, Goins KV, Chiriboga G, Fischer M, Puliafico M, Mudano AS, Rahn EJ, Merchant J, Lawrence CE, Dunkel L, Israel T, Barton B, Jenoure F, Alexander T, Cruz D, Douglas M, Sims J, Richmond A, Roberson ED, Chambless C, Harris PA, Saag KG, Lemon SC. Development of a multi-component intervention to promote participation of Black and Latinx individuals in biomedical research. J Clin Transl Sci 2021; 5:e134. [PMID: 34367678 PMCID: PMC8327553 DOI: 10.1017/cts.2021.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Barriers to research participation by racial and ethnic minority group members are multi-factorial, stem from historical social injustices and occur at participant, research team, and research process levels. The informed consent procedure is a key component of the research process and represents an opportunity to address these barriers. This manuscript describes the development of the Strengthening Translational Research in Diverse Enrollment (STRIDE) intervention, which aims to improve research participation by individuals from underrepresented groups. METHODS We used a community-engaged approach to develop an integrated, culturally, and literacy-sensitive, multi-component intervention that addresses barriers to research participation during the informed consent process. This approach involved having Community Investigators participate in intervention development activities and using community engagement studios and other methods to get feedback from community members on intervention components. RESULTS The STRIDE intervention has three components: a simulation-based training program directed toward clinical study research assistants that emphasizes cultural competency and communication skills for assisting in the informed consent process, an electronic consent (eConsent) framework designed to improve health-related research material comprehension and relevance, and a "storytelling" intervention in which prior research participants from diverse backgrounds share their experiences delivered via video vignettes during the consent process. CONCLUSIONS The community engaged development approach resulted in a multi-component intervention that addresses known barriers to research participation and can be integrated into the consent process of research studies. Results of an ongoing study will determine its effectiveness at increasing diversity among research participants.
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Affiliation(s)
- Maria I. Danila
- Department of Medicine, Division of Clinical Immunology/Rheumatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
- University of Alabama at Birmingham Center for Clinical and Translational Science, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Jeroan J. Allison
- UMass Center for Clinical and Translational Science, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Karin Valentine Goins
- UMass Center for Clinical and Translational Science, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Germán Chiriboga
- UMass Center for Clinical and Translational Science, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Melissa Fischer
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Melissa Puliafico
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Amy S. Mudano
- Department of Medicine, Division of Clinical Immunology/Rheumatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
- University of Alabama at Birmingham Center for Clinical and Translational Science, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Elizabeth J. Rahn
- Department of Medicine, Division of Clinical Immunology/Rheumatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Jeanne Merchant
- Department of Medicine, Division of Clinical Immunology/Rheumatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
- University of Alabama at Birmingham Center for Clinical and Translational Science, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Colleen E. Lawrence
- Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Leah Dunkel
- Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tiffany Israel
- Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bruce Barton
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Fred Jenoure
- UMass Center for Clinical and Translational Science, University of Massachusetts Medical School, Worcester, MA, USA
| | - Tiffany Alexander
- University of Alabama at Birmingham Center for Clinical and Translational Science, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Danny Cruz
- Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marva Douglas
- University of Alabama at Birmingham Center for Clinical and Translational Science, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Jacqueline Sims
- Vanderbilt Institute for Clinical and Translational Research (VICTR), Vanderbilt University Medical Center, Nashville, TN, USA
| | - Al Richmond
- Community Campus Partnerships for Health, Raleigh, NC, USA
| | - Erik D. Roberson
- Department of Neurology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Carol Chambless
- Department of Neurology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Paul A. Harris
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kenneth G. Saag
- Department of Medicine, Division of Clinical Immunology/Rheumatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
- University of Alabama at Birmingham Center for Clinical and Translational Science, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Stephenie C. Lemon
- UMass Center for Clinical and Translational Science, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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Community Outreach and Engagement Strategies to Address Breast Cancer Disparities. CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-020-00374-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Purpose of Review
Breast cancer disproportionately affects racial/ethnic minority women compared with their non-Hispanic white counterparts. Community-based researchers have long sought to reduce breast cancer-related health disparities using the core principles of community outreach and engagement. The primary goal of this paper is to discuss community outreach and engagement (COE) strategies in the context of breast cancer disparities and discuss evidence-based applications of COE.
Recent Findings
Evidence-based COE to address breast cancer disparities include patient navigation, co-development of community-based interventions, advisory boards, and patient boards. Recent strategies have included partnering with the Komen Tissue Bank, the development of culturally tailored expressive writing interventions, and the formation of community scientist and community mentorship programs.
Summary
Partnering with the community across all stages of research can help eliminate breast cancer disparities. We find that community outreach and engagement can improve intervention efficacy, clinical trial retention, and community commitment. We hope that this paper will promote greater adoption of evidence-based COE strategies to help eliminate breast cancer disparities.
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A CTSA-based consultation service to advance research on special and underserved populations. J Clin Transl Sci 2020; 4:271-278. [PMID: 33244406 PMCID: PMC7681147 DOI: 10.1017/cts.2020.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In this report, we describe the implementation and short-term outcomes of a Special Populations Consultation Service within the University of California, Los Angeles (UCLA) Clinical and Translational Science Institute (CTSI). With the goal of increasing the quality and quantity of special population (SP) research, the UCLA CTSI Integrating Special Populations program designed a consultation service to support faculty and trainees conducting research involving one of three CTSI “special populations:” children, older adults, and/or minority; underserved; or health disparity populations. The Special Populations Consultation Service offers three types of activities: grant proposal studios, career consultations, and project reviews. UCLA CTSI faculty with appropriate content expertise serve as consultants. We evaluated this consultation model using satisfaction surveys and by quantifying funded grants and reported changes in career goals in SP research. Between 2016 and 2019, the Special Populations Consultation Service provided 59 consultations including 42 grant studios and was used by researchers at all levels from all four UCLA CTSI institutions. Recipients rated the consultations very highly. Funding success rates were 57% following K-level grant studios and 28% following R-level grant studios. Users of project and career consultations commonly attributed career accomplishments in part to their consultation experiences. The SP Consultation Service is feasible and acceptable and appears to enhance careers of investigators studying special populations.
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Spalluto LB, Thomas D, Beard KR, Campbell T, Audet CM, McBride Murry V, Shrubsole MJ, Barajas CP, Joosten YA, Dittus RS, Wilkins CH. A Community-Academic Partnership to Reduce Health Care Disparities in Diagnostic Imaging. J Am Coll Radiol 2019; 16:649-656. [PMID: 30947902 DOI: 10.1016/j.jacr.2018.12.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Lucy B Spalluto
- Veterans Health Administration - Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center, Nashville, Tennessee and the Department of Radiological Sciences, Vanderbillt University Medical Center, Nashville, Tennessee.
| | - Debbie Thomas
- MidSouth Division of the American Cancer Society, Nashville, Tennessee
| | - Katina R Beard
- Matthew Walker Comprehensive Health Center, Nashville, Tennessee
| | - Thoris Campbell
- Metro Public Health Department, Tennessee Breast and Cervical Screening Program, Nashville, Tennessee
| | - Carolyn M Audet
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Velma McBride Murry
- Department of Human and Organizational Development, Vanderbilt University, Nashville, Tennessee
| | - Martha J Shrubsole
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Claudia P Barajas
- Office of Patient and Community Education, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
| | - Yvonne A Joosten
- Office for Community Engagement, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert S Dittus
- Veterans Health Administration - Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center, Nashville, Tennessee and the Department of Radiological Sciences, Vanderbillt University Medical Center, Nashville, Tennessee; Veterans Health Administration - Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center, Nashville, Tennessee and the Department of Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee and Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Luna Puerta L, Bartlam B, Smith HE. Researchers' perspectives on public involvement in health research in Singapore: The argument for a community-based approach. Health Expect 2019; 22:666-675. [PMID: 31322811 PMCID: PMC6737771 DOI: 10.1111/hex.12915] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 11/30/2022] Open
Abstract
Background Singapore is becoming a world‐class research hub, promoting the advancement of patient care through translational clinical research. Despite growing evidence internationally of the positive impact of public involvement (PPI), in Singapore PPI remains unusual beyond patient participation as subjects in studies. Objective To explore health researchers' understandings of the principles, role and scope of PPI, and to identify barriers and opportunities for implementation in Singapore. Design Semi‐structured qualitative interviews between April and July 2018. Data were analysed using thematic framework analysis. Results Whilst most participants (n = 20) expressed a lack of experience of PPI, the interview process provided an opportunity for reflection through which it emerged as a beneficial strategy. Interviewees highlighted both utilitarian and ethical reasons for implementing PPI, particularly around increasing the relevance and efficiency of research. In addition to those challenges to PPI documented in the existing literature, participants highlighted others specific to the Singaporean context that make PPI at an individual level unlikely to be successful, including the socio‐political environment and prevailing social and professional hierarchies. They also identified asset‐based strategies to overcome these, in particular, a more community‐oriented approach. Conclusion The cultural reluctance of individuals to question perceived authority figures such as researchers may be overcome by adopting an approach to PPI that is closer to family and local community values, and which facilitates patients and the public collectively engaging in research. Further work is needed to explore the views of patients and the public in Singapore, and the implications for other Asian communities.
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Affiliation(s)
- Lidia Luna Puerta
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Bernadette Bartlam
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore.,Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK
| | - Helen E Smith
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore.,Division of Public Health and Primary Care, Brighton and Sussex Medical School, Brighton, UK
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