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Knott CL, Miech EJ, Woodard N, Huq M. The role of organizational capacity in intervention efficacy in a church-based cancer education program: A configurational analysis. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2023; 3:284-294. [PMID: 38107832 PMCID: PMC10723821 DOI: 10.1007/s43477-023-00089-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/29/2023] [Indexed: 12/19/2023]
Abstract
It is well-established in the field of implementation science that the context in which an intervention is delivered can play a crucial role in how well it is implemented. However, less is known about how organizational context or capacity relates to efficacy outcomes, particularly with health promotion interventions delivered outside of healthcare settings. The present study examined whether organizational capacity indicators were linked to key efficacy outcomes in an evidence-based cancer control intervention delivered in 13 African American churches in Maryland. Outcomes included increases in colorectal cancer knowledge and self-report colonoscopy screening behavior from baseline to follow-up. We used Coincidence Analysis to identify features of organizational capacity that uniquely distinguished churches with varying levels of cancer knowledge and screening. Indicators of organizational capacity (e.g., congregation size, prior health promotion experience) were from an existing measure of church organizational capacity for health promotion. A single solution pathway accounted for greater increases in colorectal cancer knowledge over 12 months, a combination of two conditions: conducting 3 or more health promotion activities in the prior 2 years together with not receiving any technical assistance from outside partners in the prior 2 years. A single condition accounted for greater increases in colonoscopy screening over 24 months: churches that had conducted health promotion activities in 1-4 different topical areas in the prior 2 years. Findings highlight aspects of organizational capacity (e.g., prior experience in health promotion) that may facilitate intervention efficacy and can help practitioners identify organizational settings most promising for intervention impact.
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Affiliation(s)
- Cheryl L. Knott
- University of Maryland School of Public Health, Department of Behavioral and Community Health, 1234 School of Public Health Building, College Park, MD, 20742, USA
| | - Edward J. Miech
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
| | - Nathaniel Woodard
- University of Maryland School of Public Health, Department of Behavioral and Community Health, 1234 School of Public Health Building, College Park, MD, 20742, USA
| | - Maisha Huq
- University of Maryland School of Public Health, Department of Behavioral and Community Health, 1234 School of Public Health Building, College Park, MD, 20742, USA
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Huq MR, He X, Woodard N, Chen C, Knott CL. The role of community health advisors' cancer history in implementation and efficacy of a cancer control intervention. HEALTH EDUCATION RESEARCH 2023; 38:350-361. [PMID: 36892605 PMCID: PMC10558036 DOI: 10.1093/her/cyad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/24/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
Community health advisors (CHAs) play a key role in promoting health in medically underserved communities, including in addressing cancer disparities. There is a need to expand the research on what characteristics make for an effective CHA. We examined the relationship between CHA personal and family history of cancer, and implementation and efficacy outcomes in a cancer control intervention trial. Twenty-eight trained CHAs implemented a series of three cancer educational group workshops for N = 375 workshop participants across 14 churches. Implementation was operationalized as participant attendance at the educational workshops, and efficacy as workshop participants' cancer knowledge scores at the 12-month follow-up, controlling for baseline scores. CHA personal history of cancer was not significantly associated with implementation, nor knowledge outcomes. However, CHAs with family history of cancer had significantly greater participant attendance at the workshops than CHAs without family history of cancer (P = 0.03) and a significant, positive association with male workshop participants' prostate cancer knowledge scores at 12 months (estimated beta coefficient = 0.49, P < 0.01) after adjusting for confounders. Findings suggest that CHAs with family history of cancer may be particularly suitable for cancer peer education, although further research is needed to confirm this and identify other factors conducive to CHA success.
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Affiliation(s)
- Maisha R Huq
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD 20742, USA
| | - Xin He
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD 20742, USA
| | - Nathaniel Woodard
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD 20742, USA
| | - Chang Chen
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD 20742, USA
| | - Cheryl L Knott
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD 20742, USA
- Community Outreach and Engagement, University of Maryland Greenebaum Comprehensive Cancer Center, 22 S Greene St, Baltimore, MD 21201, USA
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Fu J, Fu C, Wang RS, Geynisman DM, Ghatalia P, Lynch SM, Harrison SR, Tagai EK, Ragin C. Current Status and Future Direction to Address Disparities in Diversity, Equity, and Inclusion in Prostate Cancer Care. Curr Oncol Rep 2023; 25:699-708. [PMID: 37010786 PMCID: PMC10068208 DOI: 10.1007/s11912-023-01399-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE OF REVIEW Disparities in prostate cancer care and outcomes have been well recognized for decades. The purpose of this review is to methodically highlight known racial disparities in the care of prostate cancer patients, and in doing so, recognize potential strategies for overcoming these disparities moving forward. RECENT FINDINGS Over the past few years, there has been a growing recognition and push towards addressing disparities in cancer care. This has led to improvements in care delivery trends and a narrowing of racial outcome disparities, but as we highlight in the following review, there is more to be addressed before we can fully close the gap in prostate cancer care delivery. While disparities in prostate cancer care are well recognized in the literature, they are not insurmountable, and progress has been made in identifying areas for improvement and potential strategies for closing the care gap.
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Affiliation(s)
- Jerry Fu
- Duke University, Durham, NC, USA
| | - Chen Fu
- Fox Chase Cancer Center, Philadelphia, PA, USA
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4
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Religiosity and Engagement in HIV Care Among African American People Living with HIV. J Racial Ethn Health Disparities 2023; 10:560-572. [PMID: 35079959 DOI: 10.1007/s40615-022-01246-1] [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: 11/21/2021] [Revised: 01/12/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
Abstract
HIV continues to disproportionately impact Black/African Americans. New and innovative strategies are needed to increase and enhance engagement in HIV care. The Black/African American church is a powerful institution with the potential to enhance HIV care among congregants. This study examines perceptions on incorporating religiosity into engagement in HIV care for African Americans living with HIV among Black/African Americans persons living with HIV, church leaders and members, and HIV health and service providers. Findings indicated Black/African Americans living with HIV would be willing to engage in religiously tailored, joint church-health initiatives to increase engagement in care. Church leaders and members and HIV health and service providers also reported a willingness to provide religiously tailored services, and that providing these services would be both acceptable and feasible for implementation. These findings should be considered in future research designed to enhance engagement in HIV care for Black/African Americans living with HIV.
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Nagler EM, Pednekar M, Sinha DN, Stoddard AM, Narake S, Adhikari K, Jones L, Lando H, Vriniotis M, Gupta P, Sorensen G. Implementation of an evidence-based tobacco control intervention for school teachers in India: Evaluating the effects of a capacity-building strategy. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231159428. [PMID: 37091538 PMCID: PMC10037724 DOI: 10.1177/26334895231159428] [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] [Indexed: 04/25/2023] Open
Abstract
Background Tobacco-Free Teachers, Tobacco-Free Society (TFT-TFS) is an evidence-based intervention that promotes tobacco use cessation among teachers and tobacco control policies among schools in India. This study tested an implementation model to build Bihar Department of Education (DOE) capacity to support and deliver TFT-TFS within schools, leveraging DOE training infrastructure. Method We used a training-of-trainers (TOT) "cascade" implementation strategy to embed the TFT-TFS program into the Bihar DOE infrastructure. We trained 46 Cluster Coordinators to train and support Headmasters to implement TFT-TFS in their schools over one academic year. We selected three school districts, representing approximately 46 clusters and 219 schools. We used the RE-AIM framework to assess program adoption (Headmaster participation in at least one of six TFT-TFS trainings), implementation (of four core program components), and reach (teachers' participation in three or more group discussions). Using a non-inferiority design, we hypothesized that program adoption, implementation, and reach would not be inferior to the high standards demonstrated when TFT-TFS was originally tested in the Bihar School Teachers Study. We used self-reported checklists to measure outcomes and SPSS Version 25 to analyze data. Results For adoption, 94% of Headmasters attended the first training, although participation declined by the sixth training. Among the 112 schools out of 219 with complete Headmaster checklist data, all met our minimum criteria for implementing TFT-TFS. Over 99% of schools posted a school tobacco control policy and distributed quit booklets. However, only 69% of schools met our criteria for program reach. Conclusions This study outlines the processes for taking a tobacco control intervention to scale and implementing it through the Bihar DOE infrastructure. These findings provide a foundation for other Indian states and low- and middle-income countries to implement tobacco control and other health programs for schoolteachers. Trial registration NCT05346991. Plain Language Summary Each year in India, more than 1.2 million people die from tobacco-related causes, and India has the world's highest oral cancer burden. The world needs more evidence on how to bring cost-effective tobacco control interventions to scale, especially in low- and middle-income countries (LMICs). To address this gap, from 2017 to 2021, we examined the process of scaling up Tobacco-Free Teachers, Tobacco-Free Society (TFT-TFS), an evidence-based intervention promoting tobacco use cessation among teachers and tobacco control policies in schools. Our study tested an implementation model aimed at building the Bihar State Department of Education (DOE) capacity to support and deliver TFT-TFS. We used a training-of-trainers model to embed TFT-TFS into Bihar DOE infrastructure, training 46 Cluster Coordinators to in turn train and support Headmasters to implement TFT-TFS over one academic year. We hypothesized that program adoption, implementation, and reach would not be inferior to the high standards demonstrated when we originally tested TFT-TFS through the Bihar School Teachers Study (2013-2017). For adoption, 94% of Headmasters attended the first training, although participation declined by the sixth training. Of 112 schools (out of 219 with complete Headmaster checklist data), all met our minimum criteria for implementing TFT-TFS. Over 99% of schools posted a school tobacco control policy and distributed quit booklets. However, only 69% of schools met our criteria for program reach. Study findings offer other Indian states and LMICs lessons to implement tobacco control and other health programs for schoolteachers within educational systems.
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Affiliation(s)
- Eve M. Nagler
- Center for Community-Based Research,
Dana-Farber
Cancer Institute, Boston, MA, USA
- Department of Social and Behavioral Sciences,
Harvard T.H.
Chan School of Public Health, Boston, MA,
USA
| | - Mangesh Pednekar
- Healis-Sekhsaria Institute for Public
Health, Navi Mumbai, India
| | | | - Anne M. Stoddard
- Center for Community-Based Research,
Dana-Farber
Cancer Institute, Boston, MA, USA
| | - Sameer Narake
- Healis-Sekhsaria Institute for Public
Health, Navi Mumbai, India
| | - Keyuri Adhikari
- School of Pharmacy, West Virginia
University, Morgantown, WV, USA
| | - Leah Jones
- Center for Community-Based Research,
Dana-Farber
Cancer Institute, Boston, MA, USA
| | - Harry Lando
- School of
Public Health, University of Minnesota,
Minneapolis, MN, USA
| | - Mary Vriniotis
- Brown-Lifespan Center for Digital Health,
Rhode Island
Hospital, Providence, RI, USA
| | - Prakash Gupta
- Healis-Sekhsaria Institute for Public
Health, Navi Mumbai, India
| | - Glorian Sorensen
- Center for Community-Based Research,
Dana-Farber
Cancer Institute, Boston, MA, USA
- Department of Social and Behavioral Sciences,
Harvard T.H.
Chan School of Public Health, Boston, MA,
USA
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Key K, Calvin K, Jordan T, Sneed RS, Bailey S, Jefferson B, Brewer A, Vincent-Doe A, Scott JB, Saunders P, Johnson-Lawrence V. Examining Community Engagement Research Strategies Used in Flint, Michigan: The Church Challenge. Prog Community Health Partnersh 2023; 17:265-276. [PMID: 37462555 PMCID: PMC10354372 DOI: 10.1353/cpr.2023.a900207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND The ways in which researchers may need to adapt traditional community-based participatory research engagement strategies during ongoing community trauma are understudied. We describe our efforts to engage the Flint, Michigan community in community-based participatory research in the aftermath of the Flint Water Crisis. OBJECTIVES This manuscript describes 1) recruitment strategies selected before the Flint Water Crisis, 2) engagement lessons learned in the context of the Flint Water Crisis, and 3) barriers and facilitators encountered while engaging African American churches. METHODS Researchers collaborated with community partners to engage and recruit a traumatized Flint community into the Church Challenge, a multilevel intervention to reduce chronic disease burden. LESSONS LEARNED Recruitment and engagement strategies must be flexible, innovative, and may require nontraditional methods. CONCLUSIONS Flexibility and adaptability are crucial for engaging with a traumatized community. Community-based participatory research work in traumatized communities must acknowledge and respond to community trauma to be successful.
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Affiliation(s)
- Kent Key
- College of Human Medicine, Michigan State University, Flint, MI
| | - Kahlil Calvin
- College of Human Medicine, Michigan State University, Flint, MI
| | - Tamara Jordan
- College of Human Medicine, Michigan State University, Flint, MI
| | | | - Sarah Bailey
- Community Based Organization Partners, Flint, MI
- Bridges to the Future, Flint, MI
| | - Bernadel Jefferson
- Community Based Organization Partners, Flint, MI
- Faith Deliverance Center, Flint, MI
| | - Allysoon Brewer
- College of Human Medicine, Michigan State University, Flint, MI
| | | | - Jamil B. Scott
- College of Human Medicine, Michigan State University, Flint, MI
- National Institutes of Health – National Human Genome Research Institute Office of the Director
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Habr D, Corsaro M. Reimagining diversity in multiple myeloma clinical trials. Hematol Oncol 2022; 40:689-694. [PMID: 35391496 PMCID: PMC9790672 DOI: 10.1002/hon.2997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Dany Habr
- Pfizer OncologyPfizer Inc.New York CityNew YorkUSA
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Lumpkins CY, Goeckner R, Hale J, Lewis C, Gunville J, Gunville R, Daley CM, Daley SM. In Our Sacred Voice - An Exploration of Tribal and Community Leader Perceptions as Health Communicators of Disease Prevention among American Indians in the Plains. HEALTH COMMUNICATION 2022; 37:1180-1191. [PMID: 34949125 DOI: 10.1080/10410236.2021.2008108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
American Indians (AI) are disproportionately and significantly impacted by disease morbidity, mortalityand poor behavioral health outcomes. Health promotion and health communication programs exist to address these health disparities and health conditions; however, few programs fully integrate holistic approaches when targeting AI populations. The objective of this study was to explore how tribal and community leaders throughout the Central Plains (Kansas, Iowa, Missouri, and South Dakota) viewed themselves as health communicators and health promoters within their communities. Members of the Center for American Indian Community Health (CAICH) conducted 39 in-depth interviews with members of federally recognized tribes living in reservation communities as well as urban tribal communities across the region. Results from the sample show that these individuals do not necessarily see themselves as the "authority" health communicator or health promoter within their tribe or community. They did perceive themselves and others as gatekeepers of pertinent health information. Social and cultural authority within culturally centered messaging and collective delivery of this type of health information from trusted sources within tribes and communities is perceived to bolster health communication programs and positively impact health outcomes among AI populations.
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Affiliation(s)
- Crystal Y Lumpkins
- Department of Family Medicine and Community Health, University of Kansas Medical Center
- William Allen White School of Journalism and Mass Communications, University of Kansas-Lawrence
| | | | - Jason Hale
- Lehigh College of Health, Institute for Indigenous Studies
| | - Charley Lewis
- Lehigh College of Health, Institute for Indigenous Studies
| | | | - River Gunville
- Lehigh College of Health, Institute for Indigenous Studies
| | - Chris M Daley
- Lehigh College of Health, Institute for Indigenous Studies
| | - Sean M Daley
- Lehigh College of Health, Institute for Indigenous Studies
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Marin DB, Karol AB, Sharma V, Wetmore J, Costello Z, Henry B, Robinson M, Thompson L, Peña I, Jandorf L. M.I.C.A.H. Project HEAL: Sustainability of a Faith-Based Community Health Advisor Training Program in Urban Underserved Communities in the USA. JOURNAL OF RELIGION AND HEALTH 2022; 61:2527-2538. [PMID: 34751869 DOI: 10.1007/s10943-021-01453-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 06/13/2023]
Abstract
Faith-based organizations (FBOs) can play an important role in improving health outcomes. Lay community health advisors (CHAs) are integral to these efforts. This paper assesses the sustainability of a CHA training program for congregants in African-American and Latino FBOs and subsequent implementation of educational workshops. The program is unique in that a health care chaplain in an academic medical center was central to the program's development and implementation. Forty-eight CHAs in 11 FBOs were trained to teach workshops on cardiovascular health, mental health, diabetes, and smoking cessation. Two thousand four hundred and forty-four participants attended 70 workshops. This program has the potential to be a model to educate individuals and to address health inequities in underserved communities. Health care chaplains in other medical centers may use this as a model for enhancing community engagement and education.
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Affiliation(s)
- Deborah B Marin
- Center for Spirituality and Health, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA.
| | - Alex B Karol
- Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA
| | - Vansh Sharma
- Center for Spirituality and Health, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA
| | - John Wetmore
- Department of Population Health and Health Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA
| | - Zorina Costello
- Center for Spirituality and Health, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA
| | - Brittney Henry
- Department of Population Health and Health Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA
| | - Mimsie Robinson
- Bethel Gospel Assembly, 2-26 East 120th Street, New York, NY, 10035, USA
| | - Linda Thompson
- Health Ministry Leader, Abyssinian Baptist Church, 132 Odell Clark Place, New York, NY, 10030, USA
| | - Israel Peña
- Department of Psychology, Boricua College, Bronx, NY, 10451, USA
- The FLOW Kingdom Ministries, 901 East Tremont Avenue, Bronx, NY, 10460, USA
| | - Lina Jandorf
- Department of Population Health and Health Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA
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Currier J, Howes D, Cox C, Bertoldi M, Sharman K, Cook B, Baden D, Farris PE, Stoller W, Shannon J. A Coordinated Approach to Implementing Low-Dose CT Lung Cancer Screening in a Rural Community Hospital. J Am Coll Radiol 2022; 19:757-768. [PMID: 35476944 DOI: 10.1016/j.jacr.2022.02.041] [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: 09/28/2021] [Revised: 02/03/2022] [Accepted: 02/19/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The authors describe a rural community hospital's approach to lung cancer screening using low-dose CT (LDCT) to address the high incidence of lung cancer mortality. METHODS An implementation project was conducted, documenting planning, education, and restructuring processes to implement a lung cancer screening program using LDCT in a rural community hospital (population 64,917, Rural-Urban Continuum Code 5) located in a region with the highest lung cancer mortality in Oregon. The hospital and community partners organized the implementation project around five recommendations for an efficient and effective lung cancer screening program that accurately identifies high-risk patients, facilitates timely access to screening, provides appropriate follow-up care, and offers smoking cessation support. RESULTS Over a 3-year period (2018-2020), 567 LDCT scans were performed among a high-risk population. The result was a 4.8-fold increase in the number of LDCT scans from 2018 to 2019 and 54% growth from 2019 to 2020. The annual adherence rate increased from 51% in 2019 to 59.6% in 2020. Cancer was detected in 2.11% of persons scanned. Among the patients in whom lung cancer was detected, the majority of cancers (66.6%) were categorized as stage I or II. CONCLUSIONS This rural community hospital's approach involved uniting primary care, specialty care, and community stakeholders around a single goal of improving lung cancer outcomes through early detection. The implementation strategy was intentionally organized around five recommendations for an effective and efficient lung cancer screening program and involved planning, education, and restructuring processes. Significant stakeholder involvement on three separate committees ensured that the program's design was relevant to local community contexts and patient centered. As a result, the screening program's reach and adherence increased each year of the 3-year pilot program.
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Affiliation(s)
- Jessica Currier
- Instructor, Division of Oncologic Sciences, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon.
| | - Deb Howes
- Director, Patient Advocacy, Kinnate Biopharma Inc., San Francisco, California
| | - Cherie Cox
- Clinical Trials Coordinator, Bay Area Hospital, Coos Bay, Oregon
| | - Margaret Bertoldi
- Nurse Manager, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Kent Sharman
- Family Medicine Specialist, North Bend Medical Center, Coos Bay, Oregon
| | - Bret Cook
- Oncologist, Bay Area Hospital, Coos Bay, Oregon
| | - Derek Baden
- Director, Gene Upshaw Memorial Tahoe Forest Cancer Center, Truckee, California
| | - Paige E Farris
- Community Research Project Director, Knight Cancer Institute's Community Outreach and Engagement Program, Oregon Health & Science University, Portland, Oregon
| | - Wesley Stoller
- Research Associate, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Jackilen Shannon
- Professor, Division of Oncologic Sciences and Associate Director, Knight Community Outreach and Engagement, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
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Luque JS, Vargas M, Wallace K, Matthew OO, Tawk R, Ali AA, Kiros GE, Harris CM, Gwede CK. Engaging the Community on Colorectal Cancer Screening Education: Focus Group Discussions Among African Americans. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:251-262. [PMID: 33904120 PMCID: PMC8075366 DOI: 10.1007/s13187-021-02019-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 05/18/2023]
Abstract
Colorectal cancer (CRC) is the third most diagnosed cancer in the USA, and African Americans experience disproportionate CRC diagnosis and mortality. Early detection could reduce CRC incidence and mortality, and reduce CRC health disparities, which may be due in part to lower screening adherence and later stage diagnosis among African Americans compared to whites. Culturally tailored interventions to increase access to and uptake of CRC stool-based tests are one effective strategy to increase benefits of screening among African Americans. The objectives of this study were to obtain feedback from African Americans on CRC educational materials being developed for a subsequent behavioral clinical trial and explore participants' knowledge, attitudes, and beliefs about CRC and CRC screening. Seven focus groups were conducted between February and November 2020. Participants were African Americans recruited through community contacts. Four focus groups were held in-person and three were conducted virtually due to Covid-19 restrictions. Participants ranked CRC educational text messages and provided feedback on a culturally tailored educational brochure. A focus group guide with scripted probes was used to elicit discussion and transcripts were analyzed using traditional content analysis. Forty-two African Americans participated. Four themes were identified from focus group discussions: (1) knowledge, attitudes, and beliefs on CRC and CRC screening; (2) reliable sources of cancer education information; (3) cultural factors affecting perspectives on health; and (4) community insights into cancer education. Participant input on the brochure was incorporated in content creation. Engaging African American community members to qualitatively examine cancer prevention has value in improving implementation strategy and planning for behavioral clinical trials.
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Affiliation(s)
- John S Luque
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA.
| | - Matthew Vargas
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Kristin Wallace
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA
- Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Olayemi O Matthew
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Rima Tawk
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Askal A Ali
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Gebre-Egziabher Kiros
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Cynthia M Harris
- College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King, Jr. Blvd, Tallahassee, FL, 32307, USA
| | - Clement K Gwede
- Moffitt Cancer Center and University of South Florida, 12902 Magnolia Dr., FOW-EDU, Tampa, FL, 33612, USA
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12
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Knott CL, Miech EJ, Slade J, Woodard N, Robinson-Shaneman BJ, Huq M. Evaluation of organizational capacity in the implementation of a church-based cancer education program. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2022; 2:22-33. [PMID: 35392361 PMCID: PMC8983006 DOI: 10.1007/s43477-021-00033-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Implementation evaluations have increasingly taken into account how features of local context help determine implementation outcomes. The purpose of this study was to determine which contextual features of organizational capacity led directly to the RE-AIM Framework implementation outcomes of intervention reach and number of days taken to implement, in an implementation trial of a series of cancer education workshops conducted across 13 African American churches in Maryland. We used a configurational approach with Coincidence Analysis to identify specific features of organizational capacity that uniquely distinguished churches with implementation success from those that were less successful. Aspects of organizational capacity (e.g., congregation size, staffing/volunteers, health ministry experience) were drawn from an existing measure of church organizational capacity for health promotion. Solution pathways leading to higher intervention reach included: having a health ministry in place for 1-4 years; or having fewer than 100 members; or mid-size churches that had conducted health promotion activities in 1-4 different topics in the past 2 years. Solution pathways to implementing the intervention in fewer number of days included: having conducted 1-2 health promotion activities in the past 2 years; or having 1-5 part-time staff and a pastor without additional outside employment; or churches with a doctorally prepared pastor and a weekly attendance of 101-249 members. Study findings can inform future theory, research, and practice in implementation of evidence-based health promotion interventions delivered in faith-based and other limited-resource community settings. Findings support the important role of organizational capacity in implementation outcomes in these settings.
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Affiliation(s)
- Cheryl L. Knott
- University of Maryland School of Public Health, Department of Behavioral and Community Health, 1234 School of Public Health Building, College Park, MD, 20742, USA.,Corresponding author: Cheryl L. Knott, PhD, University of Maryland School of Public Health, 1234W School of Public Health Building, College Park, MD 20742. Phone: 301-405-6659; Fax: 301-314-9167; ; Twitter: ChampUMD; Tumblr: champlabumd
| | - Edward J. Miech
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
| | - Jimmie Slade
- Community Ministry of Prince George’s County, PO Box 250, Upper Marlboro, MD 20773, USA
| | - Nathaniel Woodard
- University of Maryland School of Public Health, Department of Behavioral and Community Health, 1234 School of Public Health Building, College Park, MD, 20742, USA
| | | | - Maisha Huq
- University of Maryland School of Public Health, Department of Behavioral and Community Health, 1234 School of Public Health Building, College Park, MD, 20742, USA
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Luque JS, Matthew OO, Jackson DR, Vargas MA, Austin T, Ali A, Kiros GE, Harris CM, Tawk R, Gwede CK, Wallace K, Jean-Pierre P. Assessing the effectiveness of a community health advisor plus screen to save educational intervention on stool-based testing adherence in an African American safety net clinic population: study protocol for a randomized pragmatic trial. Trials 2022; 23:151. [PMID: 35168640 PMCID: PMC8845372 DOI: 10.1186/s13063-022-06076-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Colorectal cancer (CRC) is the second most deadly cancer affecting US adults and is also one of the most treatable cancers when detected at an earlier clinical stage of disease through screening. CRC health disparities experienced by African Americans are due in part to the later stage of diagnosis, suggesting the importance of improving African Americans’ CRC screening participation. The national Screen to Save (S2S) initiative employs a community health educator to deliver CRC screening education which can be tailored for specific populations, and such approaches have increased CRC screening rates in disadvantaged and racial/ethnic minority populations. Methods/design In this trial emphasizing stool-based CRC screening, focus groups informed the development of an adapted S2S video and brochure tailored for African Americans and identified preferred motivational text messages for a multicomponent community health advisor (CHA) intervention. A CHA hired from the community was trained to deliver a 6-week CRC educational intervention consisting of an initial face-to-face meeting followed by 5 weeks of calls and texts. Interested eligible persons are enrolled primarily through recruitment by two partnering community health centers (CHCs) and secondarily through various outreach channels and, after consenting and completing a baseline survey, are randomly assigned to one of two study arms. The CHCs are blinded to study arm assignment. Intervention arm participants receive the brochure and CHA intervention while participants assigned to the control group receive only the brochure. All participants receive a stool-based CRC screening test from their health center, and the primary outcome is the completion of the screening test at 12 months. Secondary objectives are to estimate the effect of the intervention on mediating factors, explore the effect of moderating factors, and perform a cost-effectiveness analysis of the CHA intervention. Discussion The TUNE-UP study will enhance understanding about CRC screening in African Americans obtaining primary health care through CHCs and is one of the very few studies to examine a CHA intervention in this context. A better understanding of the mechanisms by which the intervention affects patient beliefs and behaviors will help focus future research while the exploratory cost-effectiveness analysis will inform CHCs’ decision-making about implementing a CHA program to increase screening and reduce cancer health disparities. Trial registration ClinicalTrials.govNCT04304001. Registered on March 11, 2020.
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Affiliation(s)
- John S Luque
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA.
| | - Olayemi O Matthew
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Deloria R Jackson
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Matthew A Vargas
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Tifini Austin
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Askal Ali
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Gebre E Kiros
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Cynthia M Harris
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Rima Tawk
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Clement K Gwede
- Division of Population Sciences, Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, 33612, USA
| | - Kristin Wallace
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA.,Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Pascal Jean-Pierre
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL, 32306, USA
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Vincent-Doe A, Sneed R, Jordan T, Key K, Bailey RS, Jefferson BB, Sanders RPE, Brewer A, Scott JB, Calvin K, Summers M, Farmer B, Johnson-Lawrence V. Exploring the Readiness of African-American Churches to Engage in a Community-Engaged Blood Pressure Reduction Research Study: Lessons Learned from the Church Challenge. JOURNAL OF COMMUNITY ENGAGEMENT AND SCHOLARSHIP 2022; 14:10. [PMID: 35734421 PMCID: PMC9207767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Introduction The Transtheoretical Model (TTM) has been used to assess individual readiness for health behavior change. We describe our use of the TTM to assess organizational readiness of African-American churches to participate in the Church Challenge (CC) in Flint, Michigan; the processes of change that moved churches toward readiness for change; and lessons learned. Methods The CC was a faith-based, multilevel intervention to reduce chronic disease risk. A community-based participatory approach was used to engage and recruit churches. We used the TTM to capture church readiness for change and track church progress through the five stages. Results We engaged with 70 churches: 35 remained in Stage 1 (precontemplation), 10 remained in Stage 2 (contemplation), 3 remained in Stage 3 (preparation), 5 made it to Stage 4 (action), and 17 finished within Stage 5 (maintenance). Churches engaged in several processes of change as they moved through the various stages of change. Lessons Learned Utilizing processes of change, establishing rapport, and having previous participants share success stories helped move churches from stage-to-stage. However, certain barriers prevented progression, such as burnout/trauma from the Flint Water Crisis and scheduling conflicts. Discussion Faith-based organizational readiness greatly impacted participation in the CC. Researchers should utilize established social capital, build rapport, and remain flexible when working with African-American churches. Conclusion Although traditionally used at the individual level, the TTM works well at the organizational level to assess and monitor church readiness to participate in community-engaged research and health programming to improve health in an African-American faith community.
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Affiliation(s)
| | - Rodlescia Sneed
- Division of Public Health, Michigan State University, Flint, MI
| | - Tamara Jordan
- Division of Public Health, Michigan State University, Flint, MI
| | - Kent Key
- Division of Public Health, Michigan State University, Flint, MI,Community Based Organization Partners, Flint, MI
| | - Rev. Sarah Bailey
- Bridges to the Future, Flint, MI,Community Based Organization Partners, Flint, MI
| | | | | | - Allysoon Brewer
- Division of Public Health, Michigan State University, Flint, MI
| | - Jamil B. Scott
- Division of Public Health, Michigan State University, Flint, MI,National Human Genome Research Institute, National Institute of Health
| | - Kahlil Calvin
- Division of Public Health, Michigan State University, Flint, MI
| | - Monicia Summers
- Division of Public Health, Michigan State University, Flint, MI
| | - Bridget Farmer
- Division of Public Health, Michigan State University, Flint, MI
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Hill TG, Langley JE, Kervin EK, Pesut B, Duggleby W, Warner G. An Integrative Review on the Feasibility and Acceptability of Delivering an Online Training and Mentoring Module to Volunteers Working in Community Organizations. Front Digit Health 2021; 3:688982. [PMID: 34723241 PMCID: PMC8551809 DOI: 10.3389/fdgth.2021.688982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Volunteer programs that support older persons can assist them in accessing healthcare in an efficient and effective manner. Community-based initiatives that train volunteers to support patients with advancing illness is an important advance for public health. As part of implementing an effective community-based volunteer-based program, volunteers need to be sufficiently trained. Online training could be an effective and safe way to provide education for volunteers in both initial training and/or continuing education throughout their involvement as a volunteer. Method: We conducted an integrative review that synthesized literature on online training programs for volunteers who support older adults. The review included both a search of existing research literature in six databases, and an online search of online training programs currently being delivered in Canada. The purpose of this review was to examine the feasibility and acceptability of community-based organizations adopting an online training format for their volunteers. Results: The database search identified 13,626 records, these went through abstract and full text screen resulting in a final 15 records. This was supplemented by 2 records identified from hand searching the references, for a total of 17 articles. In addition to identifying Volunteers Roles and Responsibilities; Elements of Training; and Evaluation of Feasibility and Acceptability; a thematic analysis of the 17 records identified the categories: (1) Feasibility Promoting Factors; (2) Barriers to Feasibility; (3) Acceptability Promoting Factors; and (4) Barriers to Acceptability. Six programs were also identified in the online search of online training programs. These programs informed our understanding of delivery of existing online volunteer training programs. Discussion: Findings suggested that feasibility and acceptability of online training were promoted by (a) topic relevant training for volunteers; (b) high engagement of volunteers to prevent attrition; (c) mentorship or leadership component. Challenges to online training included a high workload; time elapsed between training and its application; and client attitude toward volunteers. Future research on online volunteer training should consider how online delivery can be most effectively paced to support volunteers in completing training and the technical skills needed to complete the training and whether teaching these skills can be integrated into programs.
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Affiliation(s)
- Taylor G Hill
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Jodi E Langley
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Emily K Kervin
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Barbara Pesut
- Nursing, University of British Columbia, Okanagan, BC, Canada
| | | | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada
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Overcoming Historical Barriers: Enhancing Positive Perceptions of Medical Research Among African Americans Through a Conference-Based Workshop. J Gen Intern Med 2021; 36:2547-2554. [PMID: 34128196 PMCID: PMC8390631 DOI: 10.1007/s11606-021-06736-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 03/17/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND African Americans (AAs) and other racial/ethnic minority groups continue to be underrepresented in medical research and clinical trials. Failure to create more racially diverse research cohorts can exacerbate existing health disparities among these groups. OBJECTIVE To investigate best practices and strategies for enhancing participation of AAs in medical research among attendees of a preconference Institute at a faith-based public health conference. DESIGN Qualitative study using semi-structured interviews. PARTICIPANTS A total of 21 out of 29 attendees (90% AA) of the Institute (72% response rate). APPROACH A culturally tailored preconference Institute was held at the 2017 Healthy Churches 2020 National Conference. The Institute was led by AA researchers focused on underrepresentation of AAs in medical research. Semi-structured interviews were conducted 1-year post-Institute (n=21) and were audio-recorded, transcribed verbatim, and reviewed using thematic analysis. KEY RESULTS The majority of attendees reported that they were more likely to participate in medical research after attending the Institute (75%). Salient learning points reported by attendees demonstrated attainment of the Institute objectives. Key themes emerged describing barriers preventing AAs from participating in medical research including fear/lack of trust, lack of information on research projects, and not being approached to participate. Key themes regarding facilitators for participation in medical research by AAs were clear communication of study objectives and research benefits along with trust in researchers. CONCLUSIONS Attendees' perceptions of participation in medical research were largely positive following their attendance at a conference-based Institute aimed to address the underrepresentation of AAs in medical research. Our culturally tailored approach to disseminating knowledge of the research process could extend to other national conferences prioritizing AAs and other racial/ethnic minority populations to improve research participation.
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Abstract
OBJECTIVES The objective of this paper was to examine the implementation and effectiveness of a community-based intervention for hoarding disorder (HD) using Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST). DESIGN This was a mixed-method, pre-post quasi-experimental study informed by the Practical, Robust Implementation and Sustainability Model for implementation science. SETTING Program activities took place in San Diego County, mainly within clients' homes or community, with some activities in-office. PARTICIPANTS Participants were aged 60 years or older, met eligibility for Medi-Cal or were uninsured, and met criteria for HD. INTERVENTION A manualized, mobile protocol that incorporated CREST was utilized. MEASUREMENTS The Clutter Image Rating and Hoarding Rating Scale were used as effectiveness outcomes. An investigator-created staff questionnaire was used to evaluate implementation. RESULTS Thirty-seven clients were reached and enrolled in treatment and 15 completed treatment during the initial 2 years of the program. There were significant changes in hoarding severity and clutter volume. Based on the initial 2 years of the program, funding was provided for expansion to cover additional San Diego County regions and hire more staff clinicians in year three. CONCLUSION Preliminary data suggest that the CREST intervention can be successfully implemented in a community setting with positive results for older adults with HD.
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Resnick B, Boltz M, Galik E, Fix S, Holmes S, Zhu S, Barr E. Testing the Implementation of Function-focused Care in Assisted Living Settings. J Am Med Dir Assoc 2021; 22:1706-1713.e1. [PMID: 33132018 PMCID: PMC8081737 DOI: 10.1016/j.jamda.2020.09.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the Function-Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT) intervention. DESIGN FFC-AL-EIT was a randomized controlled pragmatic trial including 85 sites and 794 residents. INTERVENTION FFC-AL-EIT was implemented by a Research Nurse Facilitator working with a facility champion and stakeholder team for 12 months to increase function and physical activity among residents. FFC-AL-EIT included (Step I) Environment and Policy Assessments; (Step II) Education; (Step III) Establishing Resident Function-Focused Care Service Plans; and (Step IV) Mentoring and Motivating. SETTING AND PARTICIPANTS The age of participants was 89.48 years [standard deviation (SD) = 7.43], and the majority were female (n = 561; 71%) and white (n = 771; 97%). METHODS Resident measures, obtained at baseline, 4, and 12 months, included function, physical activity, and performance of function-focused care. Setting outcomes, obtained at baseline and 12 months, included environment and policy assessments and service plans. RESULTS Reach was based on 85 of 90 sites that volunteered (94%) participating. Effectiveness was based on less decline in function (P < .001), more function-focused care (P = .012) and better environment (P = .032) and policy (P = .003) support for function-focused care in treatment sites. Adoption was supported with 10.00 (SD = 2.00) monthly meetings held, 77% of settings engaged in study activities as or more than expected, and direct care workers providing function-focused care (63% to 68% at 4 months and 90% at 12 months). The intervention was implemented as intended, and education was received based on a mean knowledge test score of 88% correct. Evidence of maintenance from 12 to 18 months was noted in treatment site environments (P = .35) and policies continuing to support function-focused care (P = .28)]. CONCLUSIONS AND IMPLICATIONS The Evidence Integration Triangle is an effective implementation approach for assisted living. Future work should continue to consider innovative approaches for measuring RE-AIM outcomes.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD, USA.
| | - Marie Boltz
- College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Elizabeth Galik
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Steven Fix
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Sarah Holmes
- Lamy Center, University of Maryland, Baltimore, MD, USA
| | - Shijun Zhu
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Eric Barr
- University of Maryland School of Nursing, Baltimore, MD, USA
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Hutto B, Saunders RP, Wilcox S, Jake-Schoffman DE, Bernhart JA, Dunn CG, Kaczynski AT, James KL. Pathways of influences leading to adoption of the Faith, Activity and Nutrition (FAN) program in a statewide initiative. EVALUATION AND PROGRAM PLANNING 2021; 87:101941. [PMID: 33773182 DOI: 10.1016/j.evalprogplan.2021.101941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/15/2020] [Accepted: 03/08/2021] [Indexed: 06/12/2023]
Abstract
RE-AIM (Reach, effectiveness, Adoption, Implementation, Maintenance) and CFIR (Consolidated Framework for Implementation Research) are complementary frameworks guiding research on dissemination and implementation of evidence-based interventions and factors influencing this process. Faith, Activity, and Nutrition (FAN) is an evidence-based program that increased physical activity and fruit and vegetable intake in faith-based settings. The aims of this adoption study were to quantify state-wide church level adoption rates and congregant reach of FAN in accordance with RE-AIM guidelines, and to explore the association of CFIR-derived constructs of the church inner setting and pastor characteristics with FAN adoption. Church recruitment was documented, and data were collected via telephone-administered surveys from 93 pastors in adopting churches and 60 pastors in non-adopting churches. Qualitative Comparative Analysis (QCA) identified combinations of CFIR-derived church and pastor characteristics sufficient for FAN adoption. As defined by RE-AIM, church-level FAN adoption was 11.7 % and congregant-level reach was 20.0 %. Fourteen pathways to adoption were identified; seven of these featured the presence of a culture of concern for congregant health along with openness to new ideas. Results suggest early assessment of these two CFIR-derived inner setting constructs may help identify faith-based organizations predisposed to undertake a comprehensive, environmental intervention to promote congregant health.
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Affiliation(s)
- Brent Hutto
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.
| | - Ruth P Saunders
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA; Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Sara Wilcox
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA; Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Danielle E Jake-Schoffman
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, 32611, USA
| | - John A Bernhart
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA; Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Caroline G Dunn
- Department of Health Policy Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Andrew T Kaczynski
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA; Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Katherine L James
- South Carolina Conference of the United Methodist Church, Columbia, SC, 29203, USA
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Knott CL, Chen C, Bowie JV, Mullins CD, Slade JL, Woodard N, Robinson-Shaneman BJR, Okwara L, Huq MR, Williams R, He X. Cluster-randomized trial comparing organizationally tailored versus standard approach for integrating an evidence-based cancer control intervention into African American churches. Transl Behav Med 2021; 12:673-682. [PMID: 34255087 DOI: 10.1093/tbm/ibab088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The field of implementation science has devoted increasing attention to optimizing the fit of evidence-based interventions to the organizational settings in which they are delivered. Institutionalization of health promotion into routine organizational operations is one way to achieve this. However, less is known about how to maximize fit and achieve institutionalization, particularly in settings outside of the healthcare system. This paper reports on findings from a parallel cluster-randomized trial that compared an organizationally tailored with a standard (core components only) approach for institutionalizing ("integrating") an evidence-based cancer control intervention into African American churches. Churches randomized to the organizationally tailored condition identified three or more implementation strategies from a menu of 20, with an implementation time frame for each. The primary study outcome was assessed through the Faith-Based Organization Health Integration Inventory, a measure of institutionalization of health promotion activities in church settings, completed by pastors at baseline and 12-month follow-up. Seventeen churches were randomized and 14 were analyzed as 3 did not implement the study protocol. Though the percent increase in total integration score was greater in the tailored condition (N = 9; 18%) than in the standard condition (N = 5; 12%), linear mixed-effect models did not detect a statistically significant group × time interaction. Despite the challenges of integrating health promotion activities outside of healthcare organizations, the current approach shows promise for fostering sustainable health promotion in community settings and merits further study.
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Affiliation(s)
- Cheryl L Knott
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD , USA
| | - Chang Chen
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
| | - Janice V Bowie
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - C Daniel Mullins
- Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, MD, USA
| | - Jimmie L Slade
- Community Ministry of Prince George's County, Upper Marlboro, MD, USA
| | - Nathaniel Woodard
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD , USA
| | | | - Leonore Okwara
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD , USA
| | - Maisha R Huq
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD , USA
| | - Ralph Williams
- Access to Wholistic and Productive Living, Inc., Colmar Manor, MD, USA
| | - Xin He
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
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Habr D, Ferdinand R. Addressing racial/ethnic disparities in cancer clinical trials: Everyone has a role to play. Cancer 2021; 127:3282-3289. [PMID: 33904590 DOI: 10.1002/cncr.33600] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 12/12/2022]
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Su D, Garg A, Wiens J, Meyer E, Cai G. Assessing Health Needs in African American Churches: A Mixed-Methods Study. JOURNAL OF RELIGION AND HEALTH 2021; 60:1179-1197. [PMID: 31595445 DOI: 10.1007/s10943-019-00924-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Among major racial and ethnic groups in the USA, African Americans are the most religious, and faith-based organizations play an important role in health promotion for African Americans. This study aimed to assess health needs in African American churches using a mixed-methods approach. Based on quantitative and qualitative data collected from eight African American churches in Nebraska in 2017, the most prevalent chronic conditions among participating African American church members (n = 388) included hypertension (60.8%), allergies (41.0%), arthritis (36.4%), high cholesterol (35.8%), and diabetes (28.1%). Significant predictors of fair or poor health were identified as male sex, unemployment, delayed utilization of health care in the past 12 months due to cost, lower frequency of church attendance, and feeling down, depressed, or hopeless in the past 2 weeks. Pastors from participating churches identified cost as one of the primary barriers to providing church-based health services. There were substantial unmet health needs in African American faith communities, especially in the areas of chronic disease prevention and management, and churches would need more support to realize their full potential in faith-based health promotion.
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Affiliation(s)
- Dejun Su
- Department of Health Promotion, College of Public Health, 984340 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE, 68198-4340, USA.
| | - Ashvita Garg
- School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Jessica Wiens
- Department of Health Promotion, College of Public Health, 984340 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE, 68198-4340, USA
| | - Eric Meyer
- Department of Health Promotion, College of Public Health, 984340 Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE, 68198-4340, USA
| | - Grace Cai
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
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Haughton J, Takemoto ML, Schneider J, Hooker SP, Rabin B, Brownson RC, Arredondo EM. Identifying barriers, facilitators, and implementation strategies for a faith-based physical activity program. Implement Sci Commun 2020; 1:51. [PMID: 32885207 PMCID: PMC7427873 DOI: 10.1186/s43058-020-00043-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background Community engagement is critical to the acceleration of evidence-based interventions into community settings. Harnessing the knowledge and opinions of community leaders increases the likelihood of successful implementation, scale-up, and sustainment of evidence-based interventions. Faith in Action (Fe en Acción) is an evidence-based promotora-led physical activity program designed to increase moderate-to-vigorous physical activity among churchgoing Latina women. Methods We conducted in-depth interviews using a semi-structured interview guide based on the Consolidated Framework for Implementation Research (CFIR) at various Catholic and Protestant churches with large Latino membership in San Diego County, California to explore barriers and facilitators to implementation of Faith in Action and identify promising implementation strategies for program scale-up and dissemination. We interviewed 22 pastors and church staff and analyzed transcripts using an iterative-deductive team approach. Results Pastors and church staff described barriers and facilitators to implementation within three domains of CFIR: characteristics of individuals (lack of self-efficacy for and knowledge of physical activity; influence on churchgoers' behaviors), inner setting (church culture and norms, alignment with mission and values, competing priorities, lack of resources), and outer setting (need for buy-in from senior leadership). From the interviews, we identified four promising implementation strategies for the scale-up of faith-based health promotion programs: (1) health behavior change training for pastors and staff, (2) tailored messaging, (3) developing community collaborations, and (4) gaining denominational support. Conclusions While churches can serve as valuable partners in health promotion, specific barriers and facilitators to implementation must be recognized and understood. Addressing these barriers through targeted implementation strategies at the adopter and organizational level can facilitate improved program implementation and lead the way for scale-up and dissemination.
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Affiliation(s)
- Jessica Haughton
- Institute for Behavioral and Community Health, San Diego State University, 9245 Sky Park Court, Suite 221, San Diego, CA 92123 USA
| | | | - Jennifer Schneider
- Institute for Behavioral and Community Health, San Diego State University, 9245 Sky Park Court, Suite 221, San Diego, CA 92123 USA
| | - Steven P Hooker
- College of Health and Human Services, San Diego State University, San Diego, CA USA
| | - Borsika Rabin
- Department of Family Medicine and Public Health, University of California, San Diego, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO USA.,Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO USA
| | - Elva M Arredondo
- School of Public Health, San Diego State University, San Diego, CA USA
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Holt CL, Tagai EK, Santos SLZ, Scheirer MA, Bowie J, Haider M, Slade J. Web-based versus in-person methods for training lay community health advisors to implement health promotion workshops: participant outcomes from a cluster-randomized trial. Transl Behav Med 2020; 9:573-582. [PMID: 29955889 DOI: 10.1093/tbm/iby065] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Project HEAL (Health through Early Awareness and Learning) is an implementation trial that compared two methods of training lay peer community health advisors (CHAs)-in-person ("Traditional") versus web-based ("Technology")-to conduct a series of three evidence-based cancer educational workshops in African American churches. This analysis reports on participant outcomes from Project HEAL. Fifteen churches were randomized to the two CHA training methods and the intervention impact was examined over 24 months. This study was conducted in Prince George's County, MD, and enrolled 375 church members age 40-75. Participants reported on knowledge and screening behaviors for breast, prostate, and colorectal cancer. Overall, cancer knowledge in all areas increased during the study period (p < .001). There were significant increases in digital rectal exam (p < .05), fecal occult blood test (p < .001), and colonoscopy (p < .01) at 24 months; however, this did not differ by study group. Mammography maintenance (56% overall) was evidenced by women reporting multiple mammograms within the study period. Participants attending all three workshops were more likely to report a fecal occult blood test or colonoscopy at 24 months (p < .05) than those who attended only one. These findings suggest that lay individuals can receive web-based training to successfully implement an evidence-based health promotion intervention that results in participant-level outcomes comparable with (a) people trained using the traditional classroom method and (b) previous efficacy trials. Findings have implications for resources and use of technology to increase widespread dissemination of evidence-based health promotion interventions through training lay persons in community settings.
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Affiliation(s)
- Cheryl L Holt
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Erin K Tagai
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Sherie Lou Zara Santos
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | | | - Janice Bowie
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Muhiuddin Haider
- School of Public Health, Institute for Applied Environmental Health, University of Maryland, College Park, MD, USA
| | - Jimmie Slade
- Community Ministry of Prince George's County, Upper Marlboro, MD, USA
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Davis CM. Health Beliefs and Breast Cancer Screening Practices Among African American Women in California. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2020; 41:259-266. [DOI: 10.1177/0272684x20942084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background African American women continue to have higher mortality rates of breast cancer when compared to other women, and evidence suggests that early detection of breast cancer can lead to favorable outcomes, yet there remains a paucity of literature about health beliefs and the utilization of three screening practices, namely breast self-examination, clinical breast examination and mammography in California, a state that currently has one of the highest breast cancer mortality rates among African American women. Purpose To investigate the relationship between health beliefs and three breast cancer detection practices, e.g. breast self-examination, clinical breast examination, and mammography in a cohort of African American women. Methods Using a descriptive correlational design, a convenience sample of two hundred and eighty-two (n = 282) self-identified women from six regional chapters of a national Black women’s political organization in California, completed a Demographic Data Questionnaire and Champion’s Health Belief Model Scale which assessed the hypothesized relationships of health beliefs and breast cancer detection practices. Results Among this culturally diverse group of women (49.8% American, 28.8% African, 21.4% West Indian), health motivation was positively related to the practice of BSE and annual physician visitation for clinical breast examinations. Health locus of control was positively related to the practice of BSE. Having relatives and friends who were diagnosed with breast cancer was strongly associated with having a mammogram and annual physician visitation for clinical breast examinations. Conclusion These findings may be used to target and develop interventions that are tailored to the unique characteristics of these diverse women.
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Affiliation(s)
- Claudia M. Davis
- Department of Nursing, Center for Promotion of Health Disparities Research and Training, California State University San Bernardino
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26
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Not One More Life: A Health and Faith Partnership Engaging At-Risk African Americans with Asthma in Atlanta. Ann Am Thorac Soc 2020; 16:421-425. [PMID: 30476439 DOI: 10.1513/annalsats.201803-166ip] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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27
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Powell TW, West KR, Turner CE. Size Matters: Addressing Social Determinants of Health Through Black Churches. J Racial Ethn Health Disparities 2020; 8:237-244. [PMID: 32472384 DOI: 10.1007/s40615-020-00777-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 01/13/2023]
Abstract
Congregational size has been most consistently linked with offering health-related programs. However, few studies have examined the unique contribution of congregational size when considering other factors and across a range of health topics including those identified as social determinants of health. The current study sought to fill this gap. Eighty-eight faith leaders from 63 Christian churches in Baltimore, Maryland, provided information about themselves, their congregations, and the programs offered in their congregations. Over half of the sample were Baptist, and 60% were women. Logistic regression analyses were conducted to examine the extent to which congregational size was associated with the likelihood of having health programs. Results showed that faith leaders from larger congregations are significantly more likely to report having more programs overall and programs that specifically target health/health care and education, even after accounting for faith leader characteristics and denomination. However, both large and small churches had an equal likelihood of offering programs related to economic stability and social/community contexts. Our findings extend previous research and suggest important next steps for researchers and practitioners to consider on how best to involve congregations in health promotion and well-being among urban communities of color.
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Affiliation(s)
- Terrinieka W Powell
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe St., E4614, Baltimore, MD, 21205, USA.
| | | | - Courtney E Turner
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
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28
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Oh A, Gaysynsky A, Knott CL, Nock NL, Erwin DO, Vinson CA. Customer discovery as a tool for moving behavioral interventions into the marketplace: insights from the NCI SPRINT program. Transl Behav Med 2019; 9:1139-1150. [PMID: 31313817 PMCID: PMC7184906 DOI: 10.1093/tbm/ibz103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The National Cancer Institute established a dissemination and implementation accelerator program called Speeding Research-tested INTerventions (SPRINT) in order to expedite the translation of behavioral research into practice. The goal of SPRINT is to introduce researchers to a new method for moving their research into practice in order to increase the real-world impact of their evidence-based interventions. The goal of this article is to present case studies on three teams that have completed the SPRINT program to date. Each case study provides a description of the intervention the team came into the program with, the team's motivation for participating in the SPRINT program, the team's experience in the program, lessons learned from "customer discovery" interviews conducted by the team during the course, and the team's future plans for their intervention. The case studies suggest that by focusing on behavioral researchers, SPRINT addresses an unmet need in the commercialization training space; that the definition of "success" can vary across SPRINT projects; that identifying and engaging "payors" for behavioral interventions is an ongoing challenge; and that there are potential "misalignments" between the research process and market demands. Overall, these examples show that customer discovery is a potentially useful method for making interventions more responsive to the needs of stakeholders, and that researchers can benefit from learning the "language" of business and working with individuals who have business experience before trying to move their research from the lab to the real world.
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Affiliation(s)
- April Oh
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Anna Gaysynsky
- Engagement and Transformation, ICF Next, Rockville, MD, USA
| | - Cheryl L Knott
- Department of Behavioral and Community Health, University of Maryland, College Park, MD, USA
| | - Nora L Nock
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Deborah O Erwin
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Cynthia A Vinson
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA
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29
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Augustin A, Ralston PA, Young-Clark I, Coccia CC. The Breast-Cancer Education and Wellness (BE Well) Intervention: Congregants' Intended Participation, Actual Participation, and Perceived Health Outcomes. HEALTH EDUCATION & BEHAVIOR 2019; 46:843-852. [PMID: 30982326 DOI: 10.1177/1090198119841114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. To evaluate a health leader-focused church-based breast cancer prevention intervention in relation to congregants' intended participation, congregants' actual participation, and perceived health outcomes at both individual and church levels using socio-ecological and theory of planned behavior frameworks. Method. Participants for the study were African American adults (n = 52) from six churches in a North Florida county involved in implementing the 9-month, three-phase intervention. Using a pre/post without comparison group design, data were collected via self-administered surveys and analyzed using qualitative and quantitative (descriptive, analysis of variance, linear regression) procedures. Results. There was general alignment between congregants' intended and actual participation when analyzed by content, especially in the areas of food and nutrition and health education. Regarding the number of intended versus actual activities, there was a significant, negative change in physical activity, a slight decline in health education activities, but a slight increase in food and nutrition activities. No significant relationships were found between extent of participation and the individual health outcomes (health ratings, health status), but significant relationships were found between extent of participation and church health outcomes (perceived role of church in improving health, p < .001; perceived role of the pastor in improving health, p < .001). Conclusions. The findings demonstrate that (1) congregants may follow through and participate in church-based health activities in which they express interest and that are made available and (2) the extent of their participation may be influenced by the perceived role of both the church and the pastor in improving their health.
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Affiliation(s)
- Angel Augustin
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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30
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Glasgow RE, Harden SM, Gaglio B, Rabin B, Smith ML, Porter GC, Ory MG, Estabrooks PA. RE-AIM Planning and Evaluation Framework: Adapting to New Science and Practice With a 20-Year Review. Front Public Health 2019; 7:64. [PMID: 30984733 PMCID: PMC6450067 DOI: 10.3389/fpubh.2019.00064] [Citation(s) in RCA: 891] [Impact Index Per Article: 178.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/05/2019] [Indexed: 01/07/2023] Open
Abstract
The RE-AIM planning and evaluation framework was conceptualized two decades ago. As one of the most frequently applied implementation frameworks, RE-AIM has now been cited in over 2,800 publications. This paper describes the application and evolution of RE-AIM as well as lessons learned from its use. RE-AIM has been applied most often in public health and health behavior change research, but increasingly in more diverse content areas and within clinical, community, and corporate settings. We discuss challenges of using RE-AIM while encouraging a more pragmatic use of key dimensions rather than comprehensive applications of all elements. Current foci of RE-AIM include increasing the emphasis on cost and adaptations to programs and expanding the use of qualitative methods to understand "how" and "why" results came about. The framework will continue to evolve to focus on contextual and explanatory factors related to RE-AIM outcomes, package RE-AIM for use by non-researchers, and integrate RE-AIM with other pragmatic and reporting frameworks.
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Affiliation(s)
- Russell E. Glasgow
- Dissemination and Implementation Science Program of ACCORDS, Department of Family Medicine, School of Medicine, University of Colorado, Aurora, CO, United States,*Correspondence: Russell E. Glasgow
| | - Samantha M. Harden
- Physical Activity Research and Community Implementation, Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Bridget Gaglio
- Patient-Centered Outcomes Research Institute, Washington, DC, United States
| | - Borsika Rabin
- Dissemination and Implementation Science Program of ACCORDS, Department of Family Medicine, School of Medicine, University of Colorado, Aurora, CO, United States,Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M University, College Station, TX, United States,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, United States,Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA, United States
| | - Gwenndolyn C. Porter
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Marcia G. Ory
- Center for Population Health and Aging, Texas A&M University, College Station, TX, United States,Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, United States
| | - Paul A. Estabrooks
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
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31
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Renfro T, Johnson E, Lambert DN, Wingood G, DiClemente RJ. The MEDIA model: An innovative method for digitizing and training community members to facilitate an HIV prevention intervention. Transl Behav Med 2019; 8:815-823. [PMID: 29471535 DOI: 10.1093/tbm/iby012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
As human immunodeficiency virus (HIV) continues to disproportionately affect African American women, practitioners remain committed to developing innovative strategies to reduce HIV prevalence. These strategies include training community organizations, such as churches, and utilizing digital media to make intervention dissemination more sustainable. This article describes one such effort to train lay community members within predominantly Black churches in Atlanta, GA, to implement an HIV prevention intervention. Lay educators were trained by translating a face-to-face Training of Facilitators (TOF) to a digital platform using the MEDIA (Motivate-Engage-Digitize-Implement-Assess) model. Formative evaluations, consultation with experts in the digital platform of choice, and the experience of two P4 for Women Master Trainers informed our translation. The model guided the translation process as our research team worked alongside topical experts and a production company to develop storyboards for core curriculum activities, which were later scripted and filmed with mock participants. A user guide, toolkit, and program website were also developed as supplemental materials to accompany the video training. Lessons learned from this study indicate future attempts at digitizing TOFs should keep in mind that digitization can be a time-consuming process, pilot testing in the new format is necessary even for a previously tested intervention, and the structure provided by facilitators in face-to-face training must be embedded into the format of digitized trainings.
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Affiliation(s)
- Tiffaney Renfro
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Erin Johnson
- Emory University Rollins School of Public Health, Atlanta, GA, USA.,American Institutes for Research (AIR), Washington, DC, USA
| | | | - Gina Wingood
- Emory University Rollins School of Public Health, Atlanta, GA, USA.,Mailman School of Public Health, Columbia University, New York, NY, USA.,Center for AIDS Research, Emory University, Atlanta, GA, USA
| | - Ralph J DiClemente
- Emory University Rollins School of Public Health, Atlanta, GA, USA.,Center for AIDS Research, Emory University, Atlanta, GA, USA
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32
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Jones LP, Slade JL, Davenport F, Santos SLZ, Knott CL. Planning for Community Scale-Up of Project HEAL: Insights From the SPRINT Initiative. Health Promot Pract 2019; 21:944-951. [PMID: 30678512 DOI: 10.1177/1524839918824087] [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] [Indexed: 11/16/2022]
Abstract
Project HEAL (Health through Early Awareness and Learning) is an evidence-based intervention rooted in health behavior change theory and aims to increase cancer awareness and early detection through African American faith-based organizations. This study explored the potential for broader scale-up and dissemination of Project HEAL with the team's participation in a training program called Speeding Research-Tested INTerventions (SPRINT). The SPRINT training was framed using tools from the Business Model Canvas and the Value Proposition Canvas to guide trainees in designing (1) compelling value propositions, (2) a minimal viable product, and (3) questions to gain critical insight from various stakeholders during a process called Customer Discovery. We report on our experiences and insights on intervention scale-up that we gained from the training, including key findings from 41 discovery interviews conducted with various stakeholders of the church. We learned several valuable lessons from the discovery interviews such as scale-up will likely be more incremental than immediate. Additional refinement is needed to scale up the intervention for "real-world" application, such as making our technology more user-friendly and including additional health topics beyond cancer. We discuss how insights from the training refined our plans for future scale-up and dissemination in a constituent-informed way.
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Affiliation(s)
| | - Jimmie L Slade
- Community Ministry of Prince George's County, Upper Marlboro, MD, USA
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Slade JL, Holt CL, Bowie J, Scheirer MA, Toussaint E, Saunders DR, Savoy A, Carter RL, Santos SL. Recruitment of African American Churches to Participate in Cancer Early Detection Interventions: A Community Perspective. JOURNAL OF RELIGION AND HEALTH 2018; 57:751-761. [PMID: 29488060 PMCID: PMC5916822 DOI: 10.1007/s10943-018-0586-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This article describes the process used to engage and recruit African American churches to serve as participants in two multi-year behavioural cancer research interventions from a community perspective. Community-based organizations used purposive sampling in engaging and recruiting advisory panel members and churches to participate in these interventions. Trust, respect, open dialogue with participants, and commitment to address community health needs contributed to successful engagement and recruitment of African American churches to serve as participants in these cancer research projects. Our results may help others engage and recruit African American churches to participate in future interventions.
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Affiliation(s)
- Jimmie L Slade
- Community Ministry of Prince George's County, Post Office Box 250, Upper Marlboro, MD, 20773, USA.
| | - Cheryl L Holt
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Janice Bowie
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Ebony Toussaint
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Darlene R Saunders
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Alma Savoy
- Community Ministry of Prince George's County, Post Office Box 250, Upper Marlboro, MD, 20773, USA
| | - Roxanne L Carter
- Community Ministry of Prince George's County, Post Office Box 250, Upper Marlboro, MD, 20773, USA
| | - Sherie Lou Santos
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
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Williams RM, Tagai EK, Santos SLZ, Slade JL, Carter RL, Holt CL. The Role of Leadership Support in a Church-Based Cancer Education Implementation Study. JOURNAL OF RELIGION AND HEALTH 2018; 57:146-156. [PMID: 28597333 PMCID: PMC5723241 DOI: 10.1007/s10943-017-0427-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Leadership plays a role in the success of an organization's initiatives. We examined church leaders' support-as perceived by lay community health advisor (CHA) interventionists-and implementation outcomes in a cancer early detection trial. CHAs perceived that their pastors: helped promote the intervention (M = 3.1/4, SD 1.2) and attended about half (M = 1.6/3, SD 1.3) the workshops. CHAs used marginally more techniques to recruit members when they perceived pastors were engaged in promoting the program (r s = .44, p = .08). Pastor attendance was positively associated with member enrollment (r s = .50, p < .05). Pastor support may be related to receptivity of both CHAs and congregants to engage in church health promotion.
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Affiliation(s)
- Randi M Williams
- Department of Behavioral and Community Health, School of Public Health (255), University of Maryland, 4200 Valley Drive, College Park, MD, 20742, USA.
| | | | - Sherie Lou Zara Santos
- Department of Behavioral and Community Health, School of Public Health (255), University of Maryland, 4200 Valley Drive, College Park, MD, 20742, USA
| | - Jimmie L Slade
- Community Ministry of Prince George's County, Upper Marlboro, MD, USA
| | - Roxanne L Carter
- Community Ministry of Prince George's County, Upper Marlboro, MD, USA
| | - Cheryl L Holt
- Department of Behavioral and Community Health, School of Public Health (255), University of Maryland, 4200 Valley Drive, College Park, MD, 20742, USA
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Tagai EK, Scheirer MA, Santos SLZ, Haider M, Bowie J, Slade J, Whitehead TL, Wang MQ, Holt CL. Assessing Capacity of Faith-Based Organizations for Health Promotion Activities. Health Promot Pract 2017; 19:714-723. [PMID: 29058956 DOI: 10.1177/1524839917737510] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Faith-based organizations (FBOs) are important venues for health promotion, particularly in medically underserved communities. These organizations vary considerably in their structural capacities, which may be linked to variability in implementation success for health promotion initiatives. Lacking an existing validated assessment of organizational capacity specific to FBOs, an initial prototype assessment was developed. METHOD The Faith-Based Organization Capacity Inventory (FBO-CI) assesses three structural areas of capacity: Staffing and Space, Health Promotion Experience, and External Collaboration. The multidisciplinary team, including FBO leaders, codeveloped the initial instrument. The initial reliability from a convenience sample of 34 African American churches including descriptions of FBOs representing three capacity levels is reported. RESULTS The FBO-CI demonstrated feasibility of administration using an in-person interview format, and the three subscales had acceptable internal reliability (α ~ .70). Most churches had an established health ministry (n = 23) and had conducted activities across an average of seven health areas in the previous 2 years. CONCLUSIONS This initial FBO-CI prototype is promising, and future work should consider validation with a larger sample of churches and domain expansion based on the conceptual model. The FBO-CI has a number of potential uses for researchers, FBO leaders, and practitioners working with FBOs in health promotion initiatives.
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Affiliation(s)
| | | | | | | | | | - Jimmie Slade
- 4 Community Ministry of Prince George's County, Upper Marlboro, MD, USA
| | | | - Min Qi Wang
- 1 University of Maryland, College Park, MD, USA
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36
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Gross TT, Story CR, Harvey IS, Allsopp M, Whitt-Glover M. "As a Community, We Need to be More Health Conscious": Pastors' Perceptions on the Health Status of the Black Church and African-American Communities. J Racial Ethn Health Disparities 2017; 5:570-579. [PMID: 28707267 DOI: 10.1007/s40615-017-0401-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/16/2017] [Accepted: 06/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Churches are recognized for their potential capacity to provide health services and interventions to address health disparities in African-Americans (blacks). Since pastors are central community leaders, their support and involvement can influence both implementation and outcomes for church-based health programs. The purpose of this qualitative study was to explore pastors' perceptions of congregant health status within the black church. METHODS Semi-structured interviews were conducted with 11 pastors whose female congregants participated in a physical activity intervention. Thematic analysis techniques were used to analyze interview data. RESULTS Three major themes emerged: (1) health risks in the African-American community, (2) health promotion in the black church, and (3) the importance of women in the black family and the church. Pastors noted numerous health disparities affecting their congregants and the African-American community at large, including obesity and infant mortality. They viewed health holistically and included faith in their perspectives. According to pastors, holistic health was promoted through health ministry programming in black churches. Women were described as the cornerstone of the black church, yet faced unique health concerns from their roles as family caretakers and congregants. DISCUSSION Pastors shared their major concerns for congregant health status and the African-American community. Health interventions focusing on African-Americans in church settings should include pastor involvement and should incorporate holistic approaches to address health risks.
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Affiliation(s)
- Tyra Toston Gross
- Public Health Sciences, Xavier University of Louisiana, New Orleans, LA, 70125, USA.
| | - Chandra R Story
- Community and Public Health, Middle Tennessee State University, Murfreesboro, TN, USA
| | - Idethia Shevon Harvey
- Department of Health and Kinesiology, Texas A&M University College, Station, TX, USA.,Transdisciplinary Center for Health Equity Research, Texas A&M University, College Station, TX, USA
| | - Marie Allsopp
- Department of Food Science, Nutrition, and Health Promotion, Mississippi State University, Starkville, MS, USA
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Scheirer MA, Santos SLZ, Tagai EK, Bowie J, Slade J, Carter R, Holt CL. Dimensions of sustainability for a health communication intervention in African American churches: a multi-methods study. Implement Sci 2017; 12:43. [PMID: 28351405 PMCID: PMC5371253 DOI: 10.1186/s13012-017-0576-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 03/21/2017] [Indexed: 11/13/2022] Open
Abstract
Background Sustainability of evidence-based health promotion interventions has received increased research attention in recent years. This paper reports sustainability data from Project HEAL (Health through Early Awareness and Learning) a cancer communication implementation trial about early detection, based in African American churches. In this paper, we used a framework by Scheirer and Dearing (Am J Publ Health 101:2059-2067, 2011) to evaluate multiple dimensions of sustainability from Project HEAL. Methods We examined the following dimensions of sustainability: (a) continued benefits for intervention recipients, (b) continuation of intervention activities, c) maintaining community partnerships, (d) changes in organizational policies or structures, (e) sustained attention to the underlying issues, (f) diffusion to additional sites, or even (g) unplanned consequences of the intervention. Project HEAL provided a three-workshop cancer educational series delivered by trained lay peer community health advisors (CHAs) in their churches. Multiple sources of sustainability were collected at 12 and 24 months after the intervention that reflect several levels of analysis: participant surveys; interviews with CHAs; records from the project’s management database; and open-ended comments from CHAs, staff, and community partners. Results Outcomes differ for each dimension of sustainability. For continued benefit, 39 and 37% of the initial 375 church members attended the 12- and 24-month follow-up workshops, respectively. Most participants reported sharing the information from Project HEAL with family or friends (92% at 12 months; 87% at 24 months). For continuation of intervention activities, some CHAs reported that the churches held at least one additional cancer educational workshop (33% at 12 months; 24% at 24 months), but many more CHAs reported subsequent health activities in their churches (71% at 12 months; 52% at 24 months). No church replicated the original series of three workshops. Additional data confirm the maintenance of community partnerships, some changes in church health policies, and continued attention to health issues by churches and CHAs. Conclusions The multiple dimensions of sustainability require different data sources and levels of analysis and show varied sustainability outcomes in this project. The findings reinforce the dynamic nature of evidence-based health interventions in community contexts. Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0576-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Sherie Lou Z Santos
- Department of Behavioral and Community Health, University of Maryland, School of Public Health, College Park, MD, USA
| | - Erin K Tagai
- Department of Behavioral and Community Health, University of Maryland, School of Public Health, College Park, MD, USA
| | - Janice Bowie
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jimmie Slade
- Community Ministry of Prince George's County, Seat Pleasant, MD, USA
| | - Roxanne Carter
- Community Ministry of Prince George's County, Seat Pleasant, MD, USA
| | - Cheryl L Holt
- Department of Behavioral and Community Health, University of Maryland, School of Public Health, College Park, MD, USA.
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