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Liu J, Liu L, James AS, Colditz GA. An overview of optimal designs under a given budget in cluster randomized trials with a binary outcome. Stat Methods Med Res 2023; 32:1420-1441. [PMID: 37284817 PMCID: PMC11020688 DOI: 10.1177/09622802231172026] [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: 06/08/2023]
Abstract
Cluster randomized trial design may raise financial concerns because the cost to recruit an additional cluster is much higher than to enroll an additional subject in subject-level randomized trials. Therefore, it is desirable to develop an optimal design. For local optimal designs, optimization means the minimum variance of the estimated treatment effect under the total budget. The local optimal design derived from the variance needs the input of an association parameter ρ in terms of a "working" correlation structure R ( ρ ) in the generalized estimating equation models. When the range of ρ instead of an exact value is available, the parameter space is defined as the range of ρ and the design space is defined as enrollment feasibility, for example, the number of clusters or cluster size. For any value ρ within the range, the optimal design and relative efficiency for each design in the design space is obtained. Then, for each design in the design space, the minimum relative efficiency within the parameter space is calculated. MaxiMin design is the optimal design that maximizes the minimum relative efficiency among all designs in the design space. Our contributions are threefold. First, for three common measures (risk difference, risk ratio, and odds ratio), we summarize all available local optimal designs and MaxiMin designs utilizing generalized estimating equation models when the group allocation proportion is predetermined for two-level and three-level parallel cluster randomized trials. We then propose the local optimal designs and MaxiMin designs using the same models when the group allocation proportion is undecided. Second, for partially nested designs, we develop the optimal designs for three common measures under the setting of equal number of subjects per cluster and exchangeable working correlation structure in the intervention group. Third, we create three new Statistical Analysis System (SAS) macros and update two existing SAS macros for all the optimal designs. We provide two examples to illustrate our methods.
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Affiliation(s)
- Jingxia Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine (WUSM), St Louis, Missouri, USA
- Division of Biostatistics, Washington University School of Medicine (WUSM), St Louis, Missouri, USA
| | - Lei Liu
- Division of Biostatistics, Washington University School of Medicine (WUSM), St Louis, Missouri, USA
| | - Aimee S James
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine (WUSM), St Louis, Missouri, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine (WUSM), St Louis, Missouri, USA
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Leone LA, Kasprzak C, Lally A, Haynes-Maslow L, Vermont LN, Horrigan-Maurer C, Tumiel-Berhalter L, Ammerman A, Raja S. A Novel Process to Recruit and Select Community Partners for a Hybrid Implementation-Effectiveness Study. Prog Community Health Partnersh 2023; 17:159-171. [PMID: 37462585 PMCID: PMC10569409 DOI: 10.1353/cpr.2023.0021] [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 Creating strong partnerships with community organizations is essential to test implementation of evidence-based interventions. However, partners are often chosen based on convenience rather than capacity or diversity. Streamlined processes are needed to identify qualified, diverse, and invested partners to conduct community-based research. OBJECTIVES There is a gap in the literature on effective and efficient processes for recruiting partners. This paper aims to fill that gap by describing a novel approach for identifying a diverse group of community organizations to participate in research. METHODS We used a Request for Partners (RFP) approach to recruit partners to participate in a hybrid implementation-effectiveness study of the Veggie Van mobile market model. The process included formative work to inform RFP development, creation of an external advisory committee, an intent-to-apply round, a full application round, and an inperson training and selection process. Data was collected to characterize applicant size, location, and experience; pre-post surveys were conducted to understand the training's utility. RESULTS We received 59 intent-to-apply submissions and invited 28 organizations to apply: 17 submitted applications and 12 organizations were chosen as finalists. The process took approximately 8 months to recruit 9 organizations and 32 community sites across 5 states and increased understanding of the intervention and partner responsibilities. CONCLUSIONS An RFP process is familiar to many community organizations that compete for grant funding but may not have prior research experience. This process streamlined recruitment timelines, increased diversity, and cultivated community among organizations. It may also improve research transparency, study completion, and intervention fidelity.
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Affiliation(s)
- Lucia A. Leone
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo
| | - Christina Kasprzak
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo
| | - Anne Lally
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo
| | | | - Leah N. Vermont
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo
| | - Caroline Horrigan-Maurer
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo
| | - Laurene Tumiel-Berhalter
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo
| | - Alice Ammerman
- Department of Nutrition, University of North Carolina at Chapel Hill, Center for Health Promotion and Disease Prevention
| | - Samina Raja
- Department of Urban and Regional Planning, School of Architecture and Planning, University at Buffalo
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3
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Earl V, Beasley D, Ye C, Halpin SN, Gauthreaux N, Escoffery C, Chawla S. Barriers and Facilitators to Colorectal Cancer Screening in African-American Men. Dig Dis Sci 2022; 67:463-472. [PMID: 33811563 DOI: 10.1007/s10620-021-06960-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 02/04/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND African-Americans rank last among all racial groups for age-adjusted colorectal cancer mortality, 5-year survival rates, and rates of screening. Access to care does not fully explain racial disparities in rates of CRC and mortality. Sociocultural attitudes can predict probabilities of CRC screening. AIMS The objective of this study is to identify factors that influence colorectal cancer screening behavior in African-American men. METHODS Semi-structured interviews were conducted among 32 African-American men. Transcripts were analyzed using MAXQDA software. We then conducted a cross-sectional survey of 103 African-American men, using previously validated scales related to colorectal cancer screening and determinants. Data were analyzed with SPSS. RESULTS In the interview phase, beliefs relating to masculinity emerged as factors that hindered participation in screening. Overwhelmingly, participants felt that having an in-depth discussion about colorectal cancer with their provider was critical to enabling them to get screened. The survey phase demonstrated that most participants had poor colorectal cancer knowledge, as only 16% passed the knowledge test. Forty-eight percentage agreed that their provider did not recommend getting screened. Those who had been previously screened for colorectal cancer scored higher in total and on all subsets of the masculinity index than those who had not (p < .01). The most persuasive messages were those related to themes of masculinity. CONCLUSION This study provides a novel sociocultural perspective about colorectal cancer screening in African-American men. Our findings highlight the importance of family, masculinity, and community when promoting colorectal cancer screening to this population.
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Affiliation(s)
- Victoria Earl
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - Derrick Beasley
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Chengcheng Ye
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Sean N Halpin
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Nicole Gauthreaux
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Cam Escoffery
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Saurabh Chawla
- Department of Digestive Diseases, Emory University School of Medicine, Atlanta, GA, USA
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4
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Lowe D, Ryan R, Schonfeld L, Merner B, Walsh L, Graham-Wisener L, Hill S. Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation. Cochrane Database Syst Rev 2021; 9:CD013373. [PMID: 34523117 PMCID: PMC8440158 DOI: 10.1002/14651858.cd013373.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Health services have traditionally been developed to focus on specific diseases or medical specialties. Involving consumers as partners in planning, delivering and evaluating health services may lead to services that are person-centred and so better able to meet the needs of and provide care for individuals. Globally, governments recommend consumer involvement in healthcare decision-making at the systems level, as a strategy for promoting person-centred health services. However, the effects of this 'working in partnership' approach to healthcare decision-making are unclear. Working in partnership is defined here as collaborative relationships between at least one consumer and health provider, meeting jointly and regularly in formal group formats, to equally contribute to and collaborate on health service-related decision-making in real time. In this review, the terms 'consumer' and 'health provider' refer to partnership participants, and 'health service user' and 'health service provider' refer to trial participants. This review of effects of partnership interventions was undertaken concurrently with a Cochrane Qualitative Evidence Synthesis (QES) entitled Consumers and health providers working in partnership for the promotion of person-centred health services: a co-produced qualitative evidence synthesis. OBJECTIVES To assess the effects of consumers and health providers working in partnership, as an intervention to promote person-centred health services. SEARCH METHODS We searched the CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL databases from 2000 to April 2019; PROQUEST Dissertations and Theses Global from 2016 to April 2019; and grey literature and online trial registries from 2000 until September 2019. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs, and cluster-RCTs of 'working in partnership' interventions meeting these three criteria: both consumer and provider participants meet; they meet jointly and regularly in formal group formats; and they make actual decisions that relate to the person-centredness of health service(s). DATA COLLECTION AND ANALYSIS Two review authors independently screened most titles and abstracts. One review author screened a subset of titles and abstracts (i.e. those identified through clinical trials registries searches, those classified by the Cochrane RCT Classifier as unlikely to be an RCT, and those identified through other sources). Two review authors independently screened all full texts of potentially eligible articles for inclusion. In case of disagreement, they consulted a third review author to reach consensus. One review author extracted data and assessed risk of bias for all included studies and a second review author independently cross-checked all data and assessments. Any discrepancies were resolved by discussion, or by consulting a third review author to reach consensus. Meta-analysis was not possible due to the small number of included trials and their heterogeneity; we synthesised results descriptively by comparison and outcome. We reported the following outcomes in GRADE 'Summary of findings' tables: health service alterations; the degree to which changed service reflects health service user priorities; health service users' ratings of health service performance; health service users' health service utilisation patterns; resources associated with the decision-making process; resources associated with implementing decisions; and adverse events. MAIN RESULTS We included five trials (one RCT and four cluster-RCTs), with 16,257 health service users and more than 469 health service providers as trial participants. For two trials, the aims of the partnerships were to directly improve the person-centredness of health services (via health service planning, and discharge co-ordination). In the remaining trials, the aims were indirect (training first-year medical doctors on patient safety) or broader in focus (which could include person-centredness of health services that targeted the public/community, households or health service delivery to improve maternal and neonatal mortality). Three trials were conducted in high income-countries, one was in a middle-income country and one was in a low-income country. Two studies evaluated working in partnership interventions, compared to usual practice without partnership (Comparison 1); and three studies evaluated working in partnership as part of a multi-component intervention, compared to the same intervention without partnership (Comparison 2). No studies evaluated one form of working in partnership compared to another (Comparison 3). The effects of consumers and health providers working in partnership compared to usual practice without partnership are uncertain: only one of the two studies that assessed this comparison measured health service alteration outcomes, and data were not usable, as only intervention group data were reported. Additionally, none of the included studies evaluating this comparison measured the other primary or secondary outcomes we sought for the 'Summary of findings' table. We are also unsure about the effects of consumers and health providers working in partnership as part of a multi-component intervention compared to the same intervention without partnership. Very low-certainty evidence indicated there may be little or no difference on health service alterations or health service user health service performance ratings (two studies); or on health service user health service utilisation patterns and adverse events (one study each). No studies evaluating this comparison reported the degree to which health service alterations reflect health service user priorities, or resource use. Overall, our confidence in the findings about the effects of working in partnership interventions was very low due to indirectness, imprecision and publication bias, and serious concerns about risk of selection bias; performance bias, detection bias and reporting bias in most studies. AUTHORS' CONCLUSIONS The effects of consumers and providers working in partnership as an intervention, or as part of a multi-component intervention, are uncertain, due to a lack of high-quality evidence and/or due to a lack of studies. Further well-designed RCTs with a clear focus on assessing outcomes directly related to partnerships for patient-centred health services are needed in this area, which may also benefit from mixed-methods and qualitative research to build the evidence base.
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Affiliation(s)
- Dianne Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Rebecca Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Lina Schonfeld
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Bronwen Merner
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Louisa Walsh
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | | | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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Liu J, Colditz GA. Sample size calculation in three-level cluster randomized trials using generalized estimating equation models. Stat Med 2020; 39:3347-3372. [PMID: 32720717 PMCID: PMC8351402 DOI: 10.1002/sim.8670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 11/22/2022]
Abstract
Three-level cluster randomized trials (CRTs) are increasingly used in implementation science, where 2fold-nested-correlated data arise. For example, interventions are randomly assigned to practices, and providers within the same practice who provide care to participants are trained with the assigned intervention. Teerenstra et al proposed a nested exchangeable correlation structure that accounts for two levels of clustering within the generalized estimating equations (GEE) approach. In this article, we utilize GEE models to test the treatment effect in a two-group comparison for continuous, binary, or count data in three-level CRTs. Given the nested exchangeable correlation structure, we derive the asymptotic variances of the estimator of the treatment effect for different types of outcomes. When the number of clusters is small, researchers have proposed bias-corrected sandwich estimators to improve performance in two-level CRTs. We extend the variances of two bias-corrected sandwich estimators to three-level CRTs. The equal provider and practice sizes were assumed to calculate number of practices for simplicity. However, they are not guaranteed in practice. Relative efficiency (RE) is defined as the ratio of variance of the estimator of the treatment effect for equal to unequal provider and practice sizes. The expressions of REs are obtained from both asymptotic variance estimation and bias-corrected sandwich estimators. Their performances are evaluated for different scenarios of provider and practice size distributions through simulation studies. Finally, a percentage increase in the number of practices is proposed due to efficiency loss from unequal provider and/or practice sizes.
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Affiliation(s)
- Jingxia Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine (WUSM), St. Louis, Missouri, USA.,Division of Biostatistics, Washington University School of Medicine (WUSM), St. Louis, Missouri, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine (WUSM), St. Louis, Missouri, USA
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Gold R, Bunce A, Cowburn S, Davis JV, Nelson JC, Nelson CA, Hicks E, Cohen DJ, Horberg MA, Melgar G, Dearing JW, Seabrook J, Mossman N, Bulkley J. Does increased implementation support improve community clinics' guideline-concordant care? Results of a mixed methods, pragmatic comparative effectiveness trial. Implement Sci 2019; 14:100. [PMID: 31805968 PMCID: PMC6894475 DOI: 10.1186/s13012-019-0948-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 10/14/2019] [Indexed: 11/18/2022] Open
Abstract
Background Disseminating care guidelines into clinical practice remains challenging, partly due to inadequate evidence on how best to help clinics incorporate new guidelines into routine care. This is particularly true in safety net community health centers (CHCs). Methods This pragmatic comparative effectiveness trial used a parallel mixed methods design. Twenty-nine CHC clinics were randomized to receive increasingly intensive implementation support (implementation toolkit (arm 1); toolkit + in-person training + training webinars (arm 2); toolkit + training + webinars + offered practice facilitation (arm 3)) targeting uptake of electronic health record (EHR) tools focused on guideline-concordant cardioprotective prescribing for patients with diabetes. Outcomes were compared across study arms, to test whether increased support yielded additive improvements, and with 137 non-study CHCs that share the same EHR as the study clinics. Quantitative data from the CHCs’ EHR were used to compare the magnitude of change in guideline-concordant ACE/ARB and statin prescribing, using adjusted Poisson regressions. Qualitative data collected using diverse methods (e.g., interviews, observations) identified factors influencing the quantitative outcomes. Results Outcomes at CHCs receiving higher-intensity support did not improve in an additive pattern. ACE/ARB prescribing did not improve in any CHC group. Statin prescribing improved overall and was significantly greater only in the arm 1 and arm 2 CHCs compared with the non-study CHCs. Factors influencing the finding of no additive impact included: aspects of the EHR tools that reduced their utility, barriers to providing the intended implementation support, and study design elements, e.g., inability to adapt the provided support. Factors influencing overall improvements in statin outcomes likely included a secular trend in awareness of statin prescribing guidelines, selection bias where motivated clinics volunteered for the study, and study participation focusing clinic staff on the targeted outcomes. Conclusions Efforts to implement care guidelines should: ensure adaptability when providing implementation support and conduct formative evaluations to determine the optimal form of such support for a given clinic; consider how study data collection influences adoption; and consider barriers to clinics’ ability to use/accept implementation support as planned. More research is needed on supporting change implementation in under-resourced settings like CHCs. Trial registration ClinicalTrials.gov, NCT02325531. Registered 15 December 2014.
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Affiliation(s)
- Rachel Gold
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR, 97227, USA. .,OCHIN, Inc., 1881 NW Naito Pkwy, Portland, OR, 97201, USA.
| | - Arwen Bunce
- OCHIN, Inc., 1881 NW Naito Pkwy, Portland, OR, 97201, USA
| | - Stuart Cowburn
- OCHIN, Inc., 1881 NW Naito Pkwy, Portland, OR, 97201, USA
| | - James V Davis
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR, 97227, USA
| | - Joan C Nelson
- OCHIN, Inc., 1881 NW Naito Pkwy, Portland, OR, 97201, USA
| | | | - Elisabeth Hicks
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Deborah J Cohen
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, 2101 East Jefferson St, Rockville, MD, 20852, USA
| | - Gerardo Melgar
- Cowlitz Family Health Center, 1057 12th Avenue, Longview, WA, 98632, USA
| | - James W Dearing
- Michigan State University, 404 Wilson Rd, Room 473, East Lansing, MI, 48824, USA
| | - Janet Seabrook
- Community HealthNet Health Centers, 1021 West 5th Avenue, Gary, IN, 46402, USA
| | - Ned Mossman
- OCHIN, Inc., 1881 NW Naito Pkwy, Portland, OR, 97201, USA
| | - Joanna Bulkley
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR, 97227, USA
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Rivers BM, Hernandez ND, Rivers D, Cooper DL, Enis SJ, Belizaire C, Matthews R. Utilizing Community-based Participatory Research Principles in a Safety-Net Hospital to Develop a Research Partnership. J Health Care Poor Underserved 2019; 30:27-35. [PMID: 31735715 DOI: 10.1353/hpu.2019.0112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Research at safety-net hospitals may require additional planning to ensure the ethical conduct of research with vulnerable populations. This report discusses application of the principles of community-based participatory research and bioethics to establish a research partnership with a safety-net hospital in the southern U.S.
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8
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Liu J, Liu L, Colditz GA. Optimal designs in three-level cluster randomized trials with a binary outcome. Stat Med 2019; 38:3733-3746. [PMID: 31162709 DOI: 10.1002/sim.8153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 12/26/2022]
Abstract
Cluster randomized trials (CRTs) were originally proposed for use when randomization at the subject level is practically infeasible or may lead to a severe estimation bias of the treatment effect. However, recruiting an additional cluster costs more than enrolling an additional subject in an individually randomized trial. Under budget constraints, researchers have proposed the optimal sample sizes in two-level CRTs. CRTs may have a three-level structure, in which two levels of clustering should be considered. In this paper, we propose optimal designs in three-level CRTs with a binary outcome, assuming a nested exchangeable correlation structure in generalized estimating equation models. We provide the variance of estimators of three commonly used measures: risk difference, risk ratio, and odds ratio. For a given sampling budget, we discuss how many clusters and how many subjects per cluster are necessary to minimize the variance of each measure estimator. For known association parameters, the locally optimal design is proposed. When association parameters are unknown but within predetermined ranges, the MaxiMin design is proposed to maximize the minimum of relative efficiency over the possible ranges, that is, to minimize the risk of the worst scenario.
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Affiliation(s)
- Jingxia Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.,Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
| | - Lei Liu
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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9
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Esplen MJ, Harrington S, Leung YW, Aronson M, Rothenmund H, Semotiuk K, Wong J, Gallinger S, Dicks E, McLaughlin J. Telephone versus in-person colorectal cancer risk and screening intervention for first-degree relatives: A randomized controlled trial. Cancer 2019; 125:2272-2282. [PMID: 30861097 PMCID: PMC6742581 DOI: 10.1002/cncr.32032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/18/2019] [Accepted: 02/01/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Having a first-degree relative (FDR) with colorectal cancer (CRC) is a significant risk factor for CRC. Counseling for FDRs regarding CRC risk factors and personalized risk is important to improve knowledge and screening compliance. METHODS A 3-arm randomized controlled trial compared tailored in-person and telephone CRC counseling interventions with controls among FDRs who were not mutation carriers for known hereditary cancer syndromes, but who were considered to be at an increased risk based on family history. It was hypothesized that both telephone and in-person approaches would increase CRC knowledge, screening adherence, perceived risk accuracy, and psychosocial functioning compared with controls. The authors anticipated greater satisfaction with the in-person approach. CRC knowledge, risk perception, psychosocial functioning, and intention to screen were assessed at baseline and at 2-week and 2-month follow-ups (primary endpoint). RESULTS A total of 278 FDRs (mean age, 47.4 years, standard deviation, 11.38 years) participated. At baseline, participants reported low to moderate CRC knowledge and overestimations of risk. Screening adherence was 73.7%. At 2 months, participants in the in-person arm and telephone arm demonstrated improvements in knowledge and perceived risk and were not found to be statistically different from each other. However, when comparing each intervention with controls, knowledge in the in-person arm was found to be statistically significantly higher, but the difference between the telephone and control arms was not. Cancer-related stress reduced over time in all groups. Intervention benefits were maintained at 1 year. Baseline screening intent/adherence were high, and therefore did not reach statistically significant improvement. CONCLUSIONS Tailored in-person or telephone formats for providing CRC risk counseling, incorporating behavioral interventions, appear to improve knowledge and risk perceptions, with high client satisfaction.
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Affiliation(s)
- Mary Jane Esplen
- de Souza Institute, University Health Network (UHN)
- Department of Psychiatry, University of Toronto
- Princess Margaret Cancer Centre, UHN
| | | | - Yvonne W Leung
- de Souza Institute, University Health Network (UHN)
- Department of Psychiatry, University of Toronto
| | - Melyssa Aronson
- Zane Cohen Centre for Digestive Diseases, Familial Gastrointestinal Cancer Registry, Mount Sinai Hospital
| | - Heidi Rothenmund
- Winnipeg Regional Health Authority; Department of Genetics & Metabolism, Health Sciences Centre in Winnipeg
| | - Kara Semotiuk
- Zane Cohen Centre for Digestive Diseases, Familial Gastrointestinal Cancer Registry, Mount Sinai Hospital
| | - Jiahui Wong
- de Souza Institute, University Health Network (UHN)
- Department of Psychiatry, University of Toronto
| | - Steven Gallinger
- Princess Margaret Cancer Centre, UHN
- Zane Cohen Centre for Digestive Diseases, Familial Gastrointestinal Cancer Registry, Mount Sinai Hospital
| | - Elizabeth Dicks
- Faculty of Medicine: Center for Health Informatics and Analytics, Memorial University
| | - John McLaughlin
- Public Health Ontario
- Dalla Lana School of Public Health, University of Toronto
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Muthukrishnan M, Arnold LD, James AS. Patients' self-reported barriers to colon cancer screening in federally qualified health center settings. Prev Med Rep 2019; 15:100896. [PMID: 31193550 PMCID: PMC6531912 DOI: 10.1016/j.pmedr.2019.100896] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 05/10/2019] [Accepted: 05/12/2019] [Indexed: 01/06/2023] Open
Abstract
Colorectal cancer (CRC) is a leading cause of cancer-related death in the United States. Despite evidence that screening reduces CRC incidence and mortality, only about 60% of age-eligible adults are up-to-date on CRC screening. This analysis aims to identify self-reported barriers to CRC screening among patients in a safety-net healthcare setting. Participants were recruited from safety-net primary care sites that were participating in a trial to increase CRC screening. At baseline, patients (n = 483) completed self-report surveys that assessed demographics, healthcare and CRC screening. Barriers to CRC screening were assessed through an open-ended question. Using a basic text analysis, data were coded and organized into key topics. Overall, 65.2% ever had CRC screening; 46.4% were up-to-date. Of those who described barriers (n = 198), 22.9% said they were not due for screening or their provider had not recommended it. Other common barriers included fear or worry about the procedure or outcome, financial challenges such as lack of insurance or cost of testing, and logistic challenges such as transportation and time. Fewer said that screening was of low importance or mentioned discomfort with the procedure or colonoscopy preparation. In this safety-net setting, CRC screening rates were lower than national rates. These qualitative results are similar to quantitative findings reported in the literature but the qualitative data add to our understanding of patient-reported concerns and challenges faced by safety-net patients. These results may be applied to developing targeting communication or intervention strategies to improve CRC screening rates within safety-net health centers.
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Affiliation(s)
- Meera Muthukrishnan
- College for Public Health and Social Justice, Saint Louis University, United States of America
- Corresponding author at: Saint Louis University, College of Public Health and Social Justice, 3545 Lafayette Ave., United States of America
| | - Lauren D. Arnold
- College for Public Health and Social Justice, Saint Louis University, United States of America
| | - Aimee S. James
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, United States of America
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Karpisheh V, Nikkhoo A, Hojjat-Farsangi M, Namdar A, Azizi G, Ghalamfarsa G, Sabz G, Yousefi M, Yousefi B, Jadidi-Niaragh F. Prostaglandin E2 as a potent therapeutic target for treatment of colon cancer. Prostaglandins Other Lipid Mediat 2019; 144:106338. [PMID: 31100474 DOI: 10.1016/j.prostaglandins.2019.106338] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/30/2019] [Accepted: 05/10/2019] [Indexed: 02/07/2023]
Abstract
Although colon cancer is one of the most important triggers of cancer related mortality, a few therapeutic options exist for this disease, including combination chemotherapy, anti-EGFR and anti-angiogenic agents. However, none of these therapeutics are fully effective for complete remission, and this issue needs further investigations, particularly in the patients with advanced disease. It has been shown that colon carcinogenesis process is associated with upregulation of prostaglandin (PG) levels. Moreover, conversion of pre-malignant cells to malignant was also related with increased generation of PGs in susceptible subjects. Among the prostanoids, PGE2 is the most important produced member which generated in high levels by colon tumor cells. Generation of PGE2 by action of cyclooxygenase (COX)-2 can promote growth and development, resistance to apoptosis, proliferation, invasion and metastasis, angiogenesis and drug resistance in colon cancer. Increased levels of PGE2 and COX-2 in colon cancer is reported by various investigators which was associated with disease progression. It is suggested that there is a positive feedback loop between COX-2 and PGE2, in which function of COX-2 induces generation of PGE2, and upregulation of PGE2 increases the expression of COX-2 in colon cancer. Although an existence of this feedback loop is well-documented, its precise mechanism, signaling pathways, and the particular E-type prostanoid (EP) receptor mediating this feedback are elusive. Therefore, it seems that targeting COX-2/PGE2/EP receptors may be supposed as a potent therapeutic strategy for treatment of colon cancer. In this review, we try to clarify the role of PGE2 in cancer progression and its targeting for treatment of colon cancer.
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Affiliation(s)
- Vahid Karpisheh
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Afshin Nikkhoo
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Hojjat-Farsangi
- Bioclinicum, Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden; The Persian Gulf Marine Biotechnology Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Afshin Namdar
- Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, T6G 2E1 Canada
| | - Gholamreza Azizi
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Ghasem Ghalamfarsa
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Gholamabas Sabz
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Mehdi Yousefi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Bahman Yousefi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farhad Jadidi-Niaragh
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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12
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Muthukrishnan M, Sutcliffe S, Hunleth JM, Wang JS, Colditz GA, James AS. Conducting a randomized trial in rural and urban safety-net health centers: Added value of community-based participatory research. Contemp Clin Trials Commun 2018; 10:29-35. [PMID: 29696155 PMCID: PMC5898527 DOI: 10.1016/j.conctc.2018.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 02/15/2018] [Accepted: 02/27/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the second most common cancer in the US. Despite evidence that screening reduces CRC incidence and mortality, screening rates are sub-optimal with disparities by race/ethnicity, income, and geography. Rural-urban differences in CRC screening are understudied even though approximately one-fifth of the US population lives in rural areas. This focus on urban populations limits the generalizability and dissemination potential of screening interventions. METHODS Using community-based participatory research (CBPR) principles, we designed a cluster-randomized trial, adaptable to a range of settings, including rural and urban health centers. We enrolled 483 participants across 11 health centers representing 2 separate networks. Both networks serve medically-underserved communities; however one is primarily rural and one primarily urban. RESULTS Our goal in this analysis is to describe baseline characteristics of participants and examine setting-level differences. CBPR was a critical for recruiting networks to the trial. Patient respondents were predominately female (61.3%), African-American (66.5%), and earned <$1200 per month (87.1%). The rural network sample was older; more likely to be female, white, disabled or retired, and have a higher income, but fewer years of education. CONCLUSIONS Variation in the samples partly reflects the CBPR process and partly reflects inherent differences in the communities. This confirmed the importance of using CBPR when planning for eventual dissemination, as it enhanced our ability to work within diverse settings. These baseline findings indicate that using a uniform approach to implementing a trial or intervention across diverse settings might not be effective or efficient.
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Affiliation(s)
- Meera Muthukrishnan
- Department of Epidemiology and Biostatistics, Saint Louis University College of Public Health and Social Justice, St. Louis, MO, USA
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jean M. Hunleth
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jean S. Wang
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Graham A. Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Aimee S. James
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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13
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Pinto RM, Witte SS, Wall MM, Filippone PL. Recruiting and retaining service agencies and public health providers in longitudinal studies: Implications for community-engaged implementation research. METHODOLOGICAL INNOVATIONS 2018; 11. [PMID: 30009043 DOI: 10.1177/2059799118770996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This article addresses a lack of attention in the implementation science literature regarding how to overcome recruitment and retention challenges in longitudinal studies involving large samples of service agencies and health service providers ("providers"). Herein, we provide a case-illustration of procedures that improved recruitment and retention in a longitudinal, mixed-method study-Project Interprofessional Collaboration Implementation-funded by the US National Institute of Mental Health. Project Interprofessional Collaboration Implementation included counselors, program workers, educators, and supervisors. We present a research-engagement model to overcome barriers that included developing a low-burden study, social gatherings to engage stakeholders, protocols to recruit agencies and providers, comprehensive record-keeping, research procedures as incentives to participation, a plan to retain hard-to-reach participants, and strategies for modifying incentives over time. Using our model, we retained 36 agencies over the life of the project. Between baseline (N = 379) and 12-month follow-up (N = 285), we retained 75% of the sample and between the 12- (N = 285) and 24-month follow-ups (N = 256), we retained 90%. For qualitative interviews (between baseline and 12-month follow-up and between 12- and 24-month follow-ups), we retained 100% of the sample (N = 20). We provide a summary of frequency of contacts required to initiate data collection and time required for data collection. The model responded to environmental changes in policy and priorities that would not have been achievable without the expertise of community partners. To recruit and retain large samples longitudinally, researchers must strategically engage community partners. The strategies imbedded in our model can be performed with moderate levels of effort and human resources. Creating opportunities for research partners to participate in all phases of the research cycle is recommended, which can help build research capacity for future research.
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Affiliation(s)
- Rogério M Pinto
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Susan S Witte
- School of Social Work, Columbia University, New York, NY, USA
| | - Melanie M Wall
- Department of Biostatistics, Mailman School of Public Health and Director of Mental Health Data Science in the Department of Psychiatry, Columbia University Medical Center and the New York State Psychiatric Institute
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14
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King AA, Baumann AA. Sickle cell disease and implementation science: A partnership to accelerate advances. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26649. [PMID: 28556441 PMCID: PMC6026013 DOI: 10.1002/pbc.26649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/05/2017] [Accepted: 04/24/2017] [Indexed: 12/11/2022]
Abstract
Sickle cell disease (SCD) results in end organ damage and a shortened lifespan. Both the pathophysiology of the disease and the social determinants of health affect patient outcomes. Randomized controlled trials have been completed among this population and resulted in medical advances; however, the gestation of these advances and the lack of penetrance into clinical practice have limited advancements in clinical improvements for many people with SCD. We discuss the role of implementation science in SCD and highlight the need for this science to shorten the length of time to implement evidence-based care for more people with SCD.
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Affiliation(s)
- Allison A. King
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
- Division of Hematology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Ana A. Baumann
- Brown School, Washington University, St. Louis, Missouri
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15
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Alberti LR, Garcia DPC, Coelho DL, Lima DCAD, Petroianu A. How to improve colon cancer screening rates. World J Gastrointest Oncol 2015; 7:484-491. [PMID: 26688708 PMCID: PMC4678395 DOI: 10.4251/wjgo.v7.i12.484] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 10/08/2015] [Accepted: 11/17/2015] [Indexed: 02/05/2023] Open
Abstract
Colorectal carcinoma is a common cause of death throughout the world and may be prevented by routine control, which can detect precancerous neoplasms and early cancers before they undergo malignant transformation or metastasis. Three strategies may improve colon cancer screening rates: convince the population about the importance of undergoing a screening test; achieve higher efficacy in standard screening tests and make them more available to the community and develop new more sensitive and efficacious screening methods and make them available as routine tests. In this light, the present study seeks to review these three means through which to increase colon cancer screening rates.
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16
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Harden SM, Gaglio B, Shoup JA, Kinney KA, Johnson SB, Brito F, Blackman KCA, Zoellner JM, Hill JL, Almeida FA, Glasgow RE, Estabrooks PA. Fidelity to and comparative results across behavioral interventions evaluated through the RE-AIM framework: a systematic review. Syst Rev 2015; 4:155. [PMID: 26547687 PMCID: PMC4637141 DOI: 10.1186/s13643-015-0141-0] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 10/23/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was developed to determine potential public health impact of interventions (i.e., programs, policy, and practice). The purpose of this systematic review was to determine (1) comparative results across accurately reported RE-AIM indicators, (2) relevant information when there remains under-reporting or misclassification of data across each dimension, (3) the degree to which authors intervened to improve outcomes related to each dimension, and (4) the number of articles reporting RE-AIM dimensions for a given study. METHODS In April 2013, a systematic search of the RE-AIM framework was completed in PubMed, PSYCHInfo, EbscoHost, Web of Science, and Scopus. Evidence was analyzed until January 2015. RESULTS Eighty-two interventions that included empirical data related to at least one of the RE-AIM dimensions were included in the review. Across these interventions, they reached a median sample size of 320 participants (M = 4894 ± 28,256). Summarizing the effectiveness indicators, we found that: the average participation rate was 45 % (±28 %), 89 % of the interventions reported positive changes in the primary outcome and 11 interventions reported broader outcomes (e.g., quality of life). As for individual-level maintenance, 11 % of studies showed effects ≥6 months post-program. Average setting and staff adoption rates were 75 % (±32 %) and 79 % (±28 %), respectively. Interventions reported being delivered as intended (82 % (±16 %)) and 22 % intervention reported adaptations to delivery. There were insufficient data to determine average maintenance at the organizational level. Data on costs associated with each dimension were infrequent and disparate: four studies reported costs of recruitment, two reported intervention costs per participant, and two reported adoption costs. CONCLUSIONS The RE-AIM framework has been employed in a variety of populations and settings for the planning, delivery, and evaluation of behavioral interventions. This review highlights inconsistencies in the degree to which authors reported each dimension in its entirety as well as inaccuracies in reporting indicators within each dimension. Further, there are few interventions that aim to improve outcomes related to reach, adoption, implementation, and maintenance.
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Affiliation(s)
- Samantha M Harden
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA.
| | - Bridget Gaglio
- Communication and Dissemination Research, Patient-Centered Outcomes Research Institute, Washington, DC, 20036, USA.
| | - Jo Ann Shoup
- School of Public Affairs, University of Colorado, Denver, CO, 80204, USA. .,Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, US.
| | - Kimberlee A Kinney
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA.
| | - Sallie Beth Johnson
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA.
| | - Fabiana Brito
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA.
| | - Kacie C A Blackman
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA. .,Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA.
| | - Jamie M Zoellner
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA.
| | - Jennie L Hill
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA.
| | - Fabio A Almeida
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA. .,Family and Community Medicine, Carilion Clinic, Roanoke, VA, 24016, USA.
| | - Russell E Glasgow
- Family Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
| | - Paul A Estabrooks
- Human Nutrition, Foods and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA. .,Family and Community Medicine, Carilion Clinic, Roanoke, VA, 24016, USA.
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17
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Le D, Holt CL, Saunders DR, Wang MQ, Coriolan A, Savoy AD, Slade JL, Muwwakkil B, Atkinson NL. Feasibility and acceptability of SMS text messaging in a prostate cancer educational intervention for African American men. Health Informatics J 2015; 22:932-947. [PMID: 26324051 DOI: 10.1177/1460458215598636] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
African Americans' greater access to mobile phones makes short messaging service technology a promising complement to health promotion interventions. Short messaging service text messages were added to the Men's Prostate Awareness Church Training project, a men's health intervention for African American men. We report on the feasibility and acceptability of the use of short messaging service text messages in the intervention. Short messaging service text messages served as (1) workshop reminders; (2) post-workshop message reinforcement; (3) spiritual/motivational messages; and (4) participant retention. At workshop 4, over 65 percent of participants wished to continue receiving the messages. While there was an increase in recall over time, more than one-third of the participants did not recall receiving the 53 text messages. However, recall was considerably greater among men who attended the Men's Prostate Awareness Church Training workshops. Overall, the inclusion of text messages in health promotion interventions targeting mature African American men was found to be feasible and acceptable.
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Affiliation(s)
- Daisy Le
- University of Maryland, USA .,Community Ministry of Prince George's County, USA .,Access to Wholistic and Productive Living Institute, Inc., USA .,Westat, USA
| | - Cheryl L Holt
- University of Maryland, USA.,Community Ministry of Prince George's County, USA.,Access to Wholistic and Productive Living Institute, Inc., USA.,Westat, USA
| | - Darlene R Saunders
- University of Maryland, USA.,Community Ministry of Prince George's County, USA.,Access to Wholistic and Productive Living Institute, Inc., USA.,Westat, USA
| | - Min Qi Wang
- University of Maryland, USA.,Community Ministry of Prince George's County, USA.,Access to Wholistic and Productive Living Institute, Inc., USA.,Westat, USA
| | | | - Alma D Savoy
- University of Maryland, USA.,Community Ministry of Prince George's County, USA.,Access to Wholistic and Productive Living Institute, Inc., USA.,Westat, USA
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18
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Gold R, Nelson C, Cowburn S, Bunce A, Hollombe C, Davis J, Muench J, Hill C, Mital M, Puro J, Perrin N, Nichols G, Turner A, Mercer M, Jaworski V, Howard C, Abiles E, Shah A, Dudl J, Chan W, DeVoe J. Feasibility and impact of implementing a private care system's diabetes quality improvement intervention in the safety net: a cluster-randomized trial. Implement Sci 2015; 10:83. [PMID: 26059264 PMCID: PMC4461907 DOI: 10.1186/s13012-015-0259-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 05/08/2015] [Indexed: 12/20/2022] Open
Abstract
Background Integrated health care delivery systems devote considerable resources to developing quality improvement (QI) interventions. Clinics serving vulnerable populations rarely have the resources for such development but might benefit greatly from implementing approaches shown to be effective in other settings. Little trial-based research has assessed the feasibility and impact of such cross-setting translation and implementation in community health centers (CHCs). We hypothesized that it would be feasible to implement successful QI interventions from integrated care settings in CHCs and would positively impact the CHCs. Methods We adapted Kaiser Permanente’s successful intervention, which targets guideline-based cardioprotective prescribing for patients with diabetes mellitus (DM), through an iterative, stakeholder-driven process. We then conducted a cluster-randomized pragmatic trial in 11 CHCs in a staggered process with six “early” CHCs implementing the intervention one year before five “‘late” CHCs. We measured monthly rates of patients with DM currently prescribed angiotensin converting enzyme (ACE)-inhibitors/statins, if clinically indicated. Through segmented regression analysis, we evaluated the intervention’s effects in June 2011–May 2013. Participants included ~6500 adult CHC patients with DM who were indicated for statins/ACE-inhibitors per national guidelines. Results Implementation of the intervention in the CHCs was feasible, with setting-specific adaptations. One year post-implementation, in the early clinics, there were estimated relative increases in guideline-concordant prescribing of 37.6 % (95 % confidence interval (CI); 29.0–46.2 %) among patients indicated for both ACE-inhibitors and statins and 38.7 % (95 % CI; 23.2–54.2 %) among patients indicated for statins. No such increases were seen in the late (control) clinics in that period. Conclusions To our knowledge, this was the first clinical trial testing the translation and implementation of a successful QI initiative from a private, integrated care setting into CHCs. This proved feasible and had significant impact but required considerable adaptation and implementation support. These results suggest the feasibility of adapting diverse strategies developed in integrated care settings for implementation in under-resourced clinics, with important implications for efficiently improving care quality in such settings. ClinicalTrials.gov NCT02299791.
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Affiliation(s)
- Rachel Gold
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97211, USA. .,OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA.
| | | | - Stuart Cowburn
- OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA.
| | - Arwen Bunce
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97211, USA.
| | - Celine Hollombe
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97211, USA.
| | - James Davis
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97211, USA.
| | - John Muench
- Oregon Health Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
| | - Christian Hill
- Virginia Garcia Memorial Health Center, 2935 SW Cedar Hills Blvd., Beaverton, OR, 97005, USA.
| | - Meena Mital
- Multnomah County Public Health Department, 426 SW Stark St, 8th Floor, Portland, OR, 97204, USA.
| | - Jon Puro
- OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA.
| | - Nancy Perrin
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97211, USA.
| | - Greg Nichols
- Kaiser Permanente Northwest Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, 97211, USA.
| | - Ann Turner
- Virginia Garcia Memorial Health Center, 2935 SW Cedar Hills Blvd., Beaverton, OR, 97005, USA.
| | - MaryBeth Mercer
- Virginia Garcia Memorial Health Center, 2935 SW Cedar Hills Blvd., Beaverton, OR, 97005, USA.
| | - Victoria Jaworski
- Multnomah County Public Health Department, 426 SW Stark St, 8th Floor, Portland, OR, 97204, USA.
| | - Colleen Howard
- OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA.
| | - Emma Abiles
- OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA.
| | - Amit Shah
- Multnomah County Public Health Department, 426 SW Stark St, 8th Floor, Portland, OR, 97204, USA.
| | - James Dudl
- Kaiser Permanente Community Benefit, 6880 Paseo Laredo, La Jolla, CA, 92037, USA.
| | - Wiley Chan
- Kaiser Permanente Northwest Medical Group, 500 NE Multnomah Street, Suite 100, Portland, OR, 97232, USA.
| | - Jennifer DeVoe
- OCHIN, Inc., 1881 SW Naito Parkway, Portland, OR, 97201, USA. .,Oregon Health Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
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19
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LoConte NK, Deming DA. Mailed invitations for colorectal screening are effective in increasing screening participation in uninsured adults with faecal immunochemical testing: the preferred screening modality. EVIDENCE-BASED MEDICINE 2014; 19:145. [PMID: 24727711 DOI: 10.1136/eb-2014-101772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Noelle K LoConte
- Department of Medicine, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Dustin A Deming
- Department of Medicine, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
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