Moving toward paradigm-shifting research in health disparities through translational, transformational, and transdisciplinary approaches

Developmental psychopathology as a meta-paradigm: From zero-sum science to epistemological pluralism in theory and research

In a thoughtful commentary in this journal a decade ago, Michael Rutter reviewed 25 years of progress in the field before concluding that developmental psychopathology (DP) initiated a paradigm shift in clinical science. This deduction requires that DP itself be a paradigm. According to Thomas Kuhn, canonical paradigms in the physical sciences serve unifying functions by consolidating scientists' thinking and scholarship around single, closed sets of discipline-defining epistemological assumptions and methods. Paradigm shifts replace these assumptions and methods with a new field-defining framework. In contrast, the social sciences are multiparadigmatic, with thinking and scholarship unified locally around open sets of epistemological assumptions and methods with varying degrees of inter-, intra-, and subdisciplinary reach. DP challenges few if any of these local paradigms. Instead, DP serves an essential pluralizing function, and is therefore better construed as a metaparadigm. Seen in this way, DP holds tremendous untapped potential to move the field from zero-sum thinking and scholarship to positive-sum science and epistemological pluralism. This integrative vision, which furthers Dante Cicchetti's legacy of interdisciplinarity, requires broad commitment among scientists to reject zero-sum scholarship in which portending theories, useful principles, and effective interventions are jettisoned based on confirmation bias, errors in logic, and ideology.

Disparities in Access to, Use of, and Quality of Rehabilitation After Stroke in the United States: A Scoping Review

OBJECTIVES

To summarize current reports in the literature on disparities in rehabilitation after stroke; identify gaps in our understanding of rehabilitation disparities; and make recommendations for future research.

DATA SOURCES

A health sciences librarian developed a search string based on an a priori protocol and searched Medline (Ovid) Embase (Elsevier), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL and EBSCO).

STUDY SELECTION

A 2-step screening process of titles and abstracts followed by full-text review was conducted. Primary observational studies conducted in the United States that reported on disparities in rehabilitation (ie, physical, occupational, or speech therapy) among adults after stroke were retained. Eligible disparity populations included racial minorities; ethnic minorities; sex and gender minorities; older populations; socioeconomically disadvantaged populations; and geographic minorities (inner city/rural).

DATA EXTRACTION

Data extracted from retained articles included: aims/objectives; data source; sample characteristics, rehabilitation outcomes examined; types of disparities examined; statistical methods used; and disparity findings.

DATA SYNTHESIS

Seven thousand eight hundred fifty-three titles and abstracts were screened, and 473 articles underwent full-text review. Forty-nine articles were included for data extraction and analysis. Many articles examined more than 1 disparity type with most examining disparities in race and/or ethnicity (n=43, 87.7%), followed by sex (n=25, 53.0%), age (n=23, 46.9%), socioeconomic status (n=22, 44.9%), and urban/rural status (n=8, 16.3%). Articles varied widely by sample characteristics, data sources, rehabilitation outcomes, and methods of examining disparities.

CONCLUSIONS

Although we found some consistent evidence of disparities in rehabilitation for older individuals, non-White races, and individuals of lower socioeconomic status, the variability in methods made the synthesis of findings challenging. Further work, including additional well-designed studies and systematic reviews, and/or meta-analyses of current studies, is needed to better understand the extent of rehabilitation disparities after stroke.

Racial and Ethnic Minorities Underrepresented in Pain Management Guidelines for Total Joint Arthroplasty: A Meta-analysis

BACKGROUND

Total joint arthroplasty aims to improve quality of life and functional outcomes for all patients, primarily by reducing their pain. This goal requires clinical practice guidelines (CPGs) that equitably represent and enroll patients from all racial/ethnic groups. To our knowledge, there has been no formal evaluation of the racial/ethnic composition of the patient population in the studies that informed the leading CPGs on the topic of pain management after arthroplasty surgery.

QUESTIONS/PURPOSES

Using papers included in the 2021 Anesthesia and Analgesia in Total Joint Arthroplasty Clinical Practice Guidelines and comparing them with US National census data, we asked: (1) What is the representation of racial/ethnic groups in randomized controlled trials compared with their representation in the US national population? (2) Is there a relationship between the reporting of racial/ethnic groups and year of data collection/publication, location of study, funding source, or guideline section?

METHODS

Participant demographic data (study year published, study type, guideline section, year of data collection, study site, study funding, study size, gender, age, and race/ethnicity) were collected from articles cited by this guideline. Studies were included if they were full text, were primary research articles conducted primarily within the United States, and if they reported racial and ethnic characteristics of the participants. The exclusion criteria included duplicate articles, articles that included the same participant population (only the latest dated article was included), and the following article types: systematic reviews, nonsystematic reviews, terminology reports, professional guidelines, expert opinions, population-based studies, surgical trials, retrospective cohort observational studies, prospective cohort observational studies, cost-effectiveness studies, and meta-analyses. Eighty-two percent (223 of 271) of articles met inclusion criteria. Our original literature search yielded 27 papers reporting the race/ethnicity of participants, including 24 US-based studies and three studies conducted in other countries; only US-based studies were utilized as the focus of this study. We defined race/ethnicity reporting as the listing of participants' race or ethnicity in the body, tables, figures, or supplemental data of a study. National census information from 2000 to 2019 was then used to generate a representation quotient (RQ), which compared the representation of racial/ethnic groups within study populations to their respective demographic representation in the national population. An RQ value greater than 1 indicates an overrepresented group and an RQ value less than 1 indicates an underrepresented group, relative to the US population. Primary outcome measures of RQ value versus time of publication for each racial/ethnic group were evaluated with linear regression analysis, and race reporting and manuscript parameters were analyzed with chi-square analyses.

RESULTS

Two US-based studies reported race and ethnicity independently. Among the 24 US-based studies reporting race/ethnicity, the overall RQ was 0.70 for Black participants, 0.09 for Hispanic participants, 0.1 for American Indian/Alaska Natives, 0 for Native Hawaiian/Pacific Islanders, 0.08 for Asian participants, and 1.37 for White participants, meaning White participants were overrepresented by 37%, Black participants were underrepresented by 30%, Hispanic participants were underrepresented by 91%, Asian participants were underrepresented by 92%, American Indian/Alaska Natives were 90% underrepresented, and Native Hawaiian Pacific Islanders were virtually not represented compared with the US national population. On chi-square analysis, there were differences between race/ethnicity reporting among studies with academic, industry, and dual-supported funding sources (χ 2 = 7.449; p = 0.02). Differences were also found between race/ethnicity reporting among US-based and non-US-based studies (χ 2 = 36.506; p < 0.001), with 93% (25 of 27) of US-based studies reporting race as opposed to only 7% (2 of 27) of non-US-based studies. Finally, there was no relationship between race/ethnicity reporting and the year of data collection or guideline section referenced.

CONCLUSION

The 2021 Anesthesia and Analgesia in Total Joint Arthroplasty Clinical Practice Guidelines provide evidence-based recommendations that reflect the current standards in orthopaedic surgery, but the studies upon which they are based overwhelmingly underenroll and underreport racial/ethnic minorities relative to their proportions in the US population. As these factors impact analgesic administration, their continued neglect may perpetuate inequities in outcomes after TJA.

CLINICAL RELEVANCE

Our study demonstrates that all non-White racial/ethnic groups were underrepresented relative to their proportion of the US population in the 2021 Anesthesia and Analgesia in Total Joint Arthroplasty Clinical Practice Guidelines, underscoring a weakness in the orthopaedic surgery evidence base and questioning the overall external validity and generalizability of these combined CPGs. An effort should be made to equitably enroll and report outcomes for all racial/ethnic groups in any updated CPGs.

Clustering of Social Determinants of Health as an Indicator of Meaningful Subgroups within an African American Population: Application of Latent Class Analysis

BACKGROUND

Health disparities between people who are African American (AA) versus their White counterparts have been well established, but disparities among AA people have not. The current study introduces a systematic method to determine subgroups within a sample of AA people based on their social determinants of health.

METHODS

Health screening data collected in the West Side of Chicago, an underserved predominantly AA area, in 2018 were used. Exploratory latent class analysis was used to determine subgroups of participants based on their responses to 16 variables, each pertaining to a specific social determinant of health.

RESULTS

Four unique clusters of participants were found, corresponding to those with "many unmet needs", "basic unmet needs", "unmet healthcare needs", and "few unmet needs".

CONCLUSION

The findings support the utility of analytically determining meaningful subgroups among a sample of AA people and their social determinants of health. Understanding the differences within an underserved population may contribute to future interventions to eliminate health disparities.

The future of translational medical humanities: bridging the data/narrative divide

This essay argues that emerging forms of translational work in the field of medical humanities offer valuable methods for engaging with communities outside of academic settings. The first section of the essay provides a synthetic overview of definitions and critical engagements with the concept of 'translation' in the context of medical humanities, a field that, in the wake of the COVID pandemic, can serve as an exemplar for other fields of the humanities. The second section explains the 'data/narrative' divide in medicine and health to demonstrate the need for new translational methodologies that can address this nexus of concern, particularly in collaboration with constituencies outside of academic settings. The third section maps out the sites and infrastructures where digital medical humanities is poised to make significant translational interventions. The final section of the essay considers data privacy and health ecology as conceptual frameworks that are necessary for bridging the data/narrative divide. Examples are drawn from the 'Translational Humanities for Public Health' website, which aggregates projects worldwide to demonstrate these emerging methodologies.

When resilience is not enough: Imagining novel approaches to supporting Black youth navigating racism

The narrative surrounding the impact racism has had on the well-being of Black youth has shifted across sociocultural and historical context. Early discourse around these topics were problem-saturated, focusing on deficits "within" Black youth. Over time, an important narrative shift occurred: greater attention was paid to the inherent assets of Black youth, their families, and communities, including how racial-ethnic protective factors such as racial socialization afforded them resilience. What resulted was decades of research seeking to understand the mechanisms that allow Black youth to bounce back in spite of racism-related adversity. Notwithstanding the viable practice and policy implications that have emerged from such inquiry, at what point does our focus on the resilience of Black youth - whether individual or multisystemic - fall short? It is with this question in mind that this paper challenges those committed to the optimal development of Black youth to consider yet another narrative shift: one that stands upon the legacy of cultural ecological frameworks and the seminal models underlying resilience research, and calls us toward not supporting Black youth's adaptation to racism, but toward collective efforts to transform our approach, pushing back against the perniciousness of racism.

Equity, diversity, and inclusion in developmental neuroscience: Practical lessons from community-based participatory research

Exclusion of racialized minorities in neuroscience directly harms communities and potentially leads to biased prevention and intervention approaches. As magnetic resonance imaging (MRI) and other neuroscientific techniques offer progressive insights into the neurobiological underpinnings of mental health research agendas, it is incumbent on us as researchers to pay careful attention to issues of diversity and representation as they apply in neuroscience research. Discussions around these issues are based largely on scholarly expert opinion without actually involving the community under study. In contrast, community-engaged approaches, specifically Community-Based Participatory Research (CBPR), actively involve the population of interest in the research process and require collaboration and trust between community partners and researchers. This paper outlines a community-engaged neuroscience approach for the development of our developmental neuroscience study on mental health outcomes in preadolescent Latina youth. We focus on "positionality" (the multiple social positions researchers and the community members hold) and "reflexivity" (the ways these positions affect the research process) as conceptual tools from social sciences and humanities. We propose that integrating two unique tools: a positionality map and Community Advisory Board (CAB) into a CBPR framework can counter the biases in human neuroscience research by making often invisible-or taken-for-granted power dynamics visible and bolstering equitable participation of diverse communities in scientific research. We discuss the benefits and challenges of incorporating a CBPR method in neuroscience research with an illustrative example of a CAB from our lab, and highlight key generalizable considerations in research design, implementation, and dissemination that we hope are useful for scholars wishing to take similar approaches.

Advocacy in community-based service learning: perspectives of community partner organizations

Background

Health advocacy is a core competency for physicians, which can be developed through community-based service-learning (CBSL). This exploratory study investigated the experiences of community partner organizations (CPOs) participating in CBSL in the context of health advocacy.

Methods

A qualitative study was conducted. Nine CPOs at a medical school participated in interviews on topics pertaining to CBSL and health advocacy. Interviews were recorded, transcribed, and coded. Major themes were identified.

Results

CPOs perceived a positive impact from CBSL through student activities and connecting with the medical community. There was no unifying definition of health advocacy. Advocacy activities varied depending on the individual's role (i.e., CPO, physician, and student), which encompassed providing patient care or services, raising awareness of healthcare issues, and influencing policy changes. CPOs had different perceptions of their role in CBSL from facilitating service-learning opportunities to teaching students in CBSL, while a few desired to be involved in curriculum development.

Conclusion

This study provides further insight into health advocacy from the lens of CPOs, which may inform changes to health advocacy training and the CanMEDS Health Advocate Role to better align with the values of community organizations. Engaging CPOs in the broader medical education system may improve health advocacy training and ensure a positive bidirectional impact.

Trans-AI/DS: transformative, transdisciplinary and translational artificial intelligence and data science

After the many ups and downs over the past 70 years of AI and 50 years of data science (DS), AI/DS have migrated into their new age. This new-generation AI/DS build on the consilience and universology of science, technology and engineering. In particular, it synergizes AI and data science, inspiring Trans-AI/DS (i.e., Trans-AI, Trans-DS and their hybridization) thinking, vision, paradigms, approaches and practices. Trans-AI/DS feature their transformative (or transformational), transdisciplinary, and translational AI/DS in terms of thinking, paradigms, methodologies, technologies, engineering, and practices. Here, we discuss these important paradigm shifts and directions. Trans-AI/DS encourage big and outside-the-box thinking beyond the classic AI, data-driven, model-based, statistical, shallow and deep learning hypotheses, methodologies and developments. They pursue foundational and original AI/DS thinking, theories and practices from the essence of intelligences and complexities inherent in humans, nature, society, and their creations.

The DASH model: Data for addressing social determinants of health in local health departments

Recent frameworks, models, and reports highlight the critical need to address social determinants of health for achieving health equity in the United States and around the globe. In the United States, data play an important role in better understanding community-level and population-level disparities particularly for local health departments. However, data-driven decision-making-the use of data for public health activities such as program implementation, policy development, and resource allocation-is often presented theoretically or through case studies in the literature. We sought to develop a preliminary model that identifies the factors that contribute to data-driven decision-making in US local health departments and describe relationships between them. Guided by implementation science literature, we examined organizational-level capacity and individual-level factors contributing to using data for decision-making related to social determinants of health and the reduction of county-level disparities. This model has the potential to improve implementation of public health interventions and programs aimed at upstream structural factors, by elucidating the factors critical to incorporating data in decision-making.

[How can participation in health promotion projects be encouraged ? Professionals' views on the key factors at play.]

INTRODUCTION

The participation of the stakeholders concerned by health promotion interventions targeting health determinants is a founding principle of integral importance. Notwithstanding the potential benefits of these approaches, their implementation is still quite limited and field practices are highly varied, if not totally heterogeneous. Such limitations can be considered in conjunction with the poorly defined outlines of participation, which can lead to variable interpretations of what it entails, and also to the different contextual factors potentially affecting its implementation. This study therefore aims: (1) to identify the various perceptions and experiences of participation, and (2) to identify the factors impacting the implementation of participation in support and development of health promotion.

METHODOLOGY

All in all, 34 professionals participated in this qualitative research, in which triangulation was associated with analysis of the written productions collected during creativity workshops (Cube activity) and semi-structured interviews and observations. All participants gave their informed consent to participate, and the data were anonymized and remained accessible to one and all. The data were subjected to content analysis (Bardin, 2003) focusing on types of factors contributing to the implementation (or non-implementation) the of participation.

RESULTS

Data analysis led to the emergence of 7 categories of factors: stakeholder characteristics, the individual characteristics of professionals and decision-makers, relations between professionals among themselves and with stakeholders, the methods and form of the approach implemented, the local organization and its missions, and the national context.

DISCUSSION

The representations and experiences of participatory approaches among health promoters are very heterogeneous. Implementation depends largely on how stakeholder characteristics are taken into account, on the ability of professionals to adapt to them, on the development of favorable interpersonal relationships through reflexive work on posture, and on the use of relevant and scientifically validated methods.

CONCLUSIONS

To strengthen the openness and motivation of field professionals to undertake participatory actions, awareness-raising and training in specific skills seems relevant, the objective being to enable them to anticipate risks and to make the most of whatever opportunities appear.

Enabling community input to improve equity in and access to translational research: The Community Coalition for Equity in Research

Background:

The COVID vaccine trials illustrated the critical need for the development of mechanisms to serve as a bridge between least advantaged communities and researchers. Such mechanisms would increase the number of studies that are designed with community needs and interests in mind, in ways that will close gaps rather than widen them. This paper reports on the creation of the Community Coalition for Equity in Research, a community-driven resource designed to build community capacity to provide researchers with credible and actionable input on study design and implementation and increase researchers’ understanding of factors that influence community support of research.

Methods and Results:

We provide a description of the Coalition’s structure and process and an evaluation of its first year of operation. Researchers rated their experience very positively and reported that the Coalition’s review will improve their research. Coalition members reported high levels of satisfaction with their participation and the processes set up for them to engage with researchers. Members also largely agreed that their participation has value for their community, and that it has increased their interest in research and the likelihood that they would recommend research participation to others.

Conclusions:

The Coalition represents a model for increasing two-way engagement between researchers and the larger community. We are optimistic that the Coalition will continue to develop and grow into a vibrant entity that will bring value to both investigators and our local communities and will increase the consideration of equity as a foundational principle in all translational research.

Equity in Genomic Medicine

Since the completion of the Human Genome Project, considerable progress has been made in translating knowledge about the genetic basis of disease risk and treatment response into clinical services and public health interventions that have greater precision. It is anticipated that more precision approaches to early detection, prevention, and treatment will be developed and will enhance equity in healthcare and outcomes among disparity populations. Reduced access to genomic medicine research, clinical services, and public health interventions has the potential to exacerbate disparities in genomic medicine. The purpose of this article is to describe these challenges to equity in genomic medicine and identify opportunities and future directions for addressing these issues. Efforts are needed to enhance access to genomic medicine research, clinical services, and public health interventions, and additional research that examines the clinical utility of precision medicine among disparity populations should be prioritized to ensure equity in genomic medicine. Expected final online publication date for the Annual Review of Genomics and Human Genetics, Volume 23 is October 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Health Inequity in Georgia During the COVID-19 Pandemic: An Ecological Analysis Assessing the Relationship Between County-Level Racial/Ethnic and Economic Polarization Using the ICE and SARS-CoV-2 Cases, Hospitalizations, and Deaths in Georgia as of October 2020

Introduction

The coronavirus disease 2019 (COVID-19) pandemic disproportionately burdens communities of color in the United States. The prevalence of preexisting conditions in these populations has not accounted for the observed health inequities. A growing body of research indicates a significant role of racialized residential segregation and income inequality on health outcomes. The Index of Concentration at the Extremes (ICE) is a metric which captures socio-spatial and economic polarization that has proven to be a valuable predictor of a large variety of health outcomes.

Objectives

The primary objective of this ecologic study was to determine the impact of socio-spatial and economic segregation on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) morbidity and mortality in Georgia.

Methods

The ICE scores for racial/ethnic, economic, and racialized economic segregation for each county in Georgia (n=159) were calculated and investigated as predictors of increased SARS-CoV-2 positivity rate, case-hospitalization rate, and case-mortality rate after controlling for the prevalence of preexisting conditions (diabetes, obesity, and smoking) and potential barriers to care (uninsured rate).

Results

Counties with the largest income disparity had 1.57 times the case rate (p<0.0001) and 1.7 times (p<0.01) the case-mortality rate compared to the most privileged counties. Cases in counties with the largest racialized economic segregation were 1.8 times more likely to be hospitalized (p<0.0001).

Conclusion

Racialized economic segregation is a strong correlate of pandemic health inequities in Georgia and highlights the need for structural interventions to address barriers to minority and vulnerable population health. Increased focus and efforts to address the structural and systematic barriers faced by communities of color is necessary to address health inequities.

Basic behavioral science research priorities in minority health and health disparities

Achieving health equity among disparity populations has been a national, regional, and local priority for several years. Health promotion and disease prevention behaviors play an important role in achieving health equity; the first generation of behavioral science studies in minority health and health disparities have provided important insights about the nature and distribution of risk exposure behaviors in disparity populations. Interventions have also been developed to enhance health promotion and disease prevention behaviors using behavioral counseling, tailored health communications, and interventions that are developed collaboratively with community stakeholders. Although intervention development and evaluation are components of transdisciplinary translational behavior research, discovery science is a critical first step in translational research. Consistent with this, conceptual models and frameworks of minority health and health disparities have evolved to include multilevel determinants that include basic behavioral mechanisms such as stress responses and stress reactivity that have physiological, psychological, and behavioral components that are relevant to minority health and health disparities. This report describes priorities, opportunities, and barriers to conducting transdisciplinary translational behavioral research during the next generation of minority health and health disparities research.

Fitting places in knowledge translation: Biomedical innovation in healthcare practice

The purpose of this study is to examine and further develop knowledge translation in the context of a biomedical device industry. Studies have yet to explain how science-based innovation is first reduced to practice in development of new biomedical technologies. To understand how this occurs, I investigated research and commercial product development in the powered prosthetic arm industry from 1945 to 2020. The findings demonstrate the foundational roles of basic knowledge translation in the production of new knowledge for the powered upper limb industry, and integrated knowledge translation in hospital and clinic-based development of powered hands. The focus on a biomedical engineering industry limits the generalizability of the findings. Future research directions include examination of other cases to identify practices in embedding research projects in locations-of-use as well as virtual fitting spaces.

Directing Research Toward Health Equity: a Health Equity Research Impact Assessment

Despite medical research advancements, inequities persist, as research has enhanced the health of some while leaving many communities untouched. Reforms are needed to direct research toward health equity, both during this pandemic and beyond. All research must currently pass scientific and ethical review processes, but neither may adequately examine a project's potential impact on inequities and local communities. Research stakeholders need practical tools to help review and examine any given study's impact on health equity. We articulate a health equity research impact assessment, which draws from existing research impact assessments and health disparities research measures and frameworks. We describe how this tool was developed and how it may be used by research reviewers, researchers, academic institutions, and funding agencies to elevate health equity in medical science.

Pilot Randomized Trial of a Transdisciplinary Geriatric and Palliative Care Intervention for Older Adults With Cancer

BACKGROUND

Oncologists often struggle with managing the unique care needs of older adults with cancer. This study sought to determine the feasibility of delivering a transdisciplinary intervention targeting the geriatric-specific (physical function and comorbidity) and palliative care (symptoms and prognostic understanding) needs of older adults with advanced cancer.

METHODS

Patients aged ≥65 years with incurable gastrointestinal or lung cancer were randomly assigned to a transdisciplinary intervention or usual care. Those in the intervention arm received 2 visits with a geriatrician, who addressed patients' palliative care needs and conducted a geriatric assessment. We predefined the intervention as feasible if >70% of eligible patients enrolled in the study and >75% of eligible patients completed study visits and surveys. At baseline and week 12, we assessed patients' quality of life (QoL), symptoms, and communication confidence. We calculated mean change scores in outcomes and estimated intervention effect sizes (ES; Cohen's d) for changes from baseline to week 12, with 0.2 indicating a small effect, 0.5 a medium effect, and 0.8 a large effect.

RESULTS

From February 2017 through June 2018, we randomized 62 patients (55.9% enrollment rate [most common reason for refusal was feeling too ill]; median age, 72.3 years; cancer types: 56.5% gastrointestinal, 43.5% lung). Among intervention patients, 82.1% attended the first visit and 79.6% attended both. Overall, 89.7% completed all study surveys. Compared with usual care, intervention patients had less QoL decrement (-0.77 vs -3.84; ES = 0.21), reduced number of moderate/severe symptoms (-0.69 vs +1.04; ES = 0.58), and improved communication confidence (+1.06 vs -0.80; ES = 0.38).

CONCLUSIONS

In this pilot trial, enrollment exceeded 55%, and >75% of enrollees completed all study visits and surveys. The transdisciplinary intervention targeting older patients' unique care needs showed encouraging ES estimates for enhancing patients' QoL, symptom burden, and communication confidence.

Racial Differences in Patient Portal Activation and Research Enrollment Among Patients With Prostate Cancer

PURPOSE

The purpose of this study was to examine racial differences in patient portal activation and research participation among patients with prostate cancer.

MATERIALS AND METHODS

Participants were African American and White patients with prostate cancer who were treated with radical prostatectomy (n = 218). Patient portal activation was determined using electronic health records, and research participation was measured based on completion of a social determinants survey.

RESULTS

Thirty-one percent of patients completed the social determinants survey and enrolled in the study and 66% activated a patient portal. The likelihood of enrolling in the study was reduced with greater levels of social deprivation (odds ratio [OR], 0.70; 95% CI, 0.50 to 0.98; P = .04). Social deprivation also had a signification independent association with patient portal activation along with racial background. African American patients (OR, 0.48; 95% CI, 0.23 to 0.91; P = .02) and those with greater social deprivation (OR, 0.58; 95% CI, 0.42 to 0.82; P = .002) had a lower likelihood of activating a patient portal compared with White patients and those with lower social deprivation.

CONCLUSION

Although the majority of patients with prostate cancer activated their patient portal, rates of patient portal activation were lower among African American patients and those who lived in areas with greater social deprivation. Greater efforts are needed to promote patient portal activation among African American patients with prostate cancer and address access to health information technology among those who live in socially disadvantaged geographic areas.

The Mitigating Toxic Stress study design: approaches to developmental evaluation of pediatric health care innovations addressing social determinants of health and toxic stress

Background

Health care administrators must establish and promote effective partnerships with community agencies to address social determinants of health, including reducing exposure of infants and young children to chronic stress. Because infants’ experiences are inextricably tied to their caregivers, an important target for mitigating “toxic” stress exposure in early childhood is through reducing parents’ experiences of chronic stress in addition to protecting children from direct experiences of harm such as physical or sexual abuse. Conducting screening to identify when children are exposed to early life adversity is a first step; connecting families to needed support services is an essential component to addressing identified challenges. This paper presents the methodology of a three-year study of health care systems innovations designed to engage and support parents of infants to prevent and mitigate children’s toxic stress exposures.

Methods

Key study features included: 1) multi-component study in five U.S. communities and nine pediatric health care clinics and the families they serve, 2) a developmental evaluation approach to describe how innovations are experienced over time at three levels—community systems, pediatric providers, and families, and 3) rapid cycle feedback conducted with communities, clinics and families to co-interpret data and findings. Data sources included: 1) focus groups and interviews with community stakeholders, clinic staff, and families, 2) electronic health record and Medicaid services data extracted to assess health care quality, utilization, and financial impact, and 3) clinic-recruitment of 908 parents of infants in a longitudinal survey. Results. The sample is briefly characterized based on responses to the enrollment phase of the parent survey.

Conclusions

We discuss the study design elements’ contribution to generating evidence needed by innovators, communities, and clinics to modify and sustain investments in these innovations to prevent or mitigate the effects of exposure to toxic stress on young children.

Effectively Confronting the COVID-19 Pandemic: Critical Lessons From HIV Prevention, Care, and Treatment and Innovative Strategies to Conduct Community-Based and Community-Engaged Research Safely

Coronavirus disease 2019 (COVID-19) is a new infectious disease caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The COVID-19 pandemic has profoundly altered the ways in which members of communities live, learn, work, and play. Similarly, the pandemic has affected the conduct of community-based and community-engaged research, which are essential research approaches to promoting health equity, reducing health disparities, and improving community and population health. In this commentary, we outline nine lessons from HIV prevention, care, and treatment that are particularly relevant to reducing the impact of the COVID-19 pandemic. We also identify ten innovative strategies to reduce exposure to SARS-CoV-2 among teams and community members conducting community-based and community-engaged research. Implementation of these strategies will help to ensure these research approaches can safely continue during the pandemic and that communities and populations continue to benefit from research designed to promote equity, reduce disparities, and improve health.

Evaluating the process of partnership and research in global health: reflections from the STRIPE project

Background

Thoughtful and equitable engagement with international partners is key to successful research. STRIPE, a consortium of 8 academic and research institutions across the globe whose objective is to map, synthesize, and disseminate lessons learned from polio eradication, conducted a process evaluation of this partnership during the project’s first year which focused on knowledge mapping activities.

Methods

The STRIPE consortium is led by Johns Hopkins University (JHU) in partnership with 6 universities and 1 research consultancy organization in polio free, at-risk, and endemic countries. In December 2018 JHU team members submitted written reflections on their experiences (n = 9). We held calls with each consortium member to solicit additional feedback (n = 7). To establish the partnership evaluation criteria we conducted preliminary analyses based on Blackstock’s framework evaluating participatory research. In April 2019, an in-person consortium meeting was held; one member from each institution was asked to join a process evaluation working group. This group reviewed the preliminary criteria, adding, subtracting, and combining as needed; the final evaluation criteria were applied to STRIPE’s research process and partnership and illustrative examples were provided.

Results

Twelve evaluation criteria were defined and applied by each member of the consortium to their experience in the project. These included access to resources, expectation setting, organizational context, external context, quality of information, relationship building, transparency, motivation, scheduling, adaptation, communication and engagement, and capacity building. For each criteria members of the working group reflected on general and context-specific challenges and potential strategies to overcome them. Teams suggested providing more time for recruitment, training, reflection, pre-testing. and financing to alleviate resource constraints. Given the large scope of the project, competing priorities, and shifting demands the working group also suggested a minimum of one full-time project coordinator in each setting to manage resources.

Conclusion

Successful management of multi-country, multicentered implementation research requires comprehensive communication tools (which to our knowledge do not exist yet or are not readily available), expectation setting, and institutional support. Capacity building activities that address human resource needs for both individuals and their institutions should be incorporated into early project planning.

Qualitative research in epidemiology: theoretical and methodological perspectives

Increasingly, modern epidemiology has adopted complex causal frameworks incorporating individual- and population-level determinants of health. Despite the growing use of qualitative methodologies in public health research generally, discussion of causal reasoning in epidemiology rarely considers evidence derived from qualitative research. This article argues for a coherent role of qualitative research within epidemiology through analysis of the principles of causal reasoning that underlie current debates about causal inference in epidemiology. It introduces two approaches to causal inference by Russo and Williamson (2009) and Reiss (2012) that emphasize the relevance of both the nature of causation and how knowledge is gained about causation in assessing evidence for a causal relation. Both theories have scope for incorporating multiple types of evidence to assess causal claims. We argue that these theories align with the empirical focus of epidemiology and allow for different types of evidence to evaluate causal claims, including evidence originating from qualitative research; such evidence can contribute to a mechanistic understanding of causal relations and to understanding the effects of context on health-related outcomes. Finally, we discuss this approach in light of previous literature on the role of qualitative research in epidemiology and implications for future epidemiologic research.

A critical realist synthesis of cross-disciplinary health policy and systems research: defining characteristic features, developing an evaluation framework and identifying challenges

BACKGROUND

Health policy and systems research (HPSR) is an inherently cross-disciplinary field of investigation. However, conflicting conceptualisations about inter-, multi- and transdisciplinary research have contributed to confusion about the characteristics of cross-disciplinary approaches in HPSR. This review was conducted to (1) define the characteristic features of context-mechanism-outcome (CMO) configurations in cross-disciplinary HPSR, (2) develop criteria for evaluating cross-disciplinarity and (3) synthesise emerging challenges of the approach.

METHOD

The paper is a critical realist synthesis conducted in three phases, as follows: (1) scoping the literature, (2) searching for and screening the evidence, and (3) extracting and synthesising the evidence. Five databases, namely the International Bibliography of the Social Sciences and Web of Science, PubMed central, Embase and CINHAL, and reference lists of studies that qualified for inclusion in the review were searched. The search covered peer-reviewed original research, reviews, commentary papers, and institutional or government reports published in English between January 1998 and January 2020.

RESULTS

A total of 7792 titles were identified in the online search and 137 publications, comprising pilot studies as well as anecdotal and empirical literature were selected for the final review. The review draws attention to the fact that cross-disciplinary HPSR is not defined by individual characteristics but by the combination of a particular type of research question and setting (context), a specific way of researchers working together (mechanism), and research output (outcome) that is superior to what could be achieved under a monodisciplinary approach. This CMO framework also informs the criteria for assessing whether a given HPSR is truly cross-disciplinary. The challenges of cross-disciplinary HPSR and their accompanying coping mechanisms were also found to be context driven, originating mainly from conceptual disagreements, institutional restrictions, communication and information management challenges, coordination problems, and resource limitations.

CONCLUSION

These findings have important implications. First, the CMO framework of cross-disciplinary HPSR can provide guidance for researchers engaging in new projects and for policy-makers using their findings. Second, the proposed criteria for evaluating theory and practice of cross-disciplinary HPSR may inform the systematic development of new research projects and the structured assessment of existing ones. Third, a better understanding of the challenges of cross-disciplinary HPSR and potential response mechanisms may help researchers to avoid these problems in the future.

Rationale and Design of Distance-Based Training to Persuade Local Health Department Employees that Addressing Social Determinants of Health Is Their Job, Too

Public health workers in local health departments frequently rate skills needed to address social determinants of health among their top training needs. These workers have the ability to impact social determinants of health, but many may believe this responsibility is not part of their job description or that they do not have the necessary skills or resources. Guided by the Elaboration Likelihood Model of Persuasion and employing the case study method of instruction, the Region 2 Public Health Training Center designed a 45-minute, self-paced, online training module, titled Strategies to Advance Health Equity: How Health Departments Can Promote Living Wages, to persuade public health workers that addressing social determinants of health, especially those related to income disparities, is part of their day-to-day responsibilities. This article describes the module design, promising preliminary assessment data, and the formal evaluation plan.

Addressing power dynamics in community-engaged research partnerships

BACKGROUND

Successful community-engaged research depends on the quality of the collaborative partnerships between community -members and academic researchers and may take several forms depending on the purpose which dictates the degree to which power dynamics are handled within the collaborative arrangement.

METHODS

To understand the power dynamics and related concepts within community-engaged research arrangements, a secondary analysis of an existing qualitative data set was undertaken. Two models of community-engaged research, a review of literature, and the applied experiences of researchers familiar with community engagement practices confirmed the power dynamics concepts used to carry out the analysis of the qualitative data set according to the principles of directed content analysis. This analysis yielded quotes on power dynamics and related issues. Tools to address the power dynamics exposed by the quotes were selected using the literature and lived experience of the researchers. Finally, to ensure trustworthiness, the selected quotes on power dynamics and the recommended tools were subjected to naturalistic treatment using peer debriefings and triangulation.

RESULTS

Analysis of existing qualitative data made clear that community-engaged research between health practitioners and communities may take several forms depending on the purpose and dictate how power dynamics, including inequities, biases, discrimination, racism, rank and privilege, are handled within the collaborative arrangement. Three tools including implicit bias training, positionality, and structural competency may be used to address power dynamics and related concepts.

CONCLUSION

Analysis of the qualitative data set highlighted the power dynamics within different community-engaged research models and the tools that may be used to address inequitable power dynamics including implicit bias training, positionality, and structural competency.

Towards Convergence: How to Do Transdisciplinary Environmental Health Disparities Research

Increasingly, funders (i.e., national, public funders, such as the National Institutes of Health and National Science Foundation in the U.S.) and scholars agree that single disciplines are ill equipped to study the pressing social, health, and environmental problems we face alone, particularly environmental exposures, increasing health disparities, and climate change. To better understand these pressing social problems, funders and scholars have advocated for transdisciplinary approaches in order to harness the analytical power of diverse and multiple disciplines to tackle these problems and improve our understanding. However, few studies look into how to conduct such research. To this end, this article provides a review of transdisciplinary science, particularly as it relates to environmental research and public health. To further the field, this article provides in-depth information on how to conduct transdisciplinary research. Using the case of a transdisciplinary, community-based, participatory action, environmental health disparities study in California's Central Valley provides an in-depth look at how to do transdisciplinary research. Working with researchers from the fields of social sciences, public health, biological engineering, and land, air, and water resources, this study aims to answer community residents' questions related to the health disparities they face due to environmental exposure. Through this case study, I articulate not only the logistics of how to conduct transdisciplinary research but also the logics. The implications for transdisciplinary methodologies in health disparity research are further discussed, particularly in the context of team science and convergence science.

Structural Interventions to Reduce and Eliminate Health Disparities

Health disparities research in the United States over the past 2 decades has yielded considerable progress and contributed to a developing evidence base for interventions that tackle disparities in health status and access to care. However, health disparity interventions have focused primarily on individual and interpersonal factors, which are often limited in their ability to yield sustained improvements. Health disparities emerge and persist through complex mechanisms that include socioeconomic, environmental, and system-level factors. To accelerate the reduction of health disparities and yield enduring health outcomes requires broader approaches that intervene upon these structural determinants. Although an increasing number of innovative programs and policies have been deployed to address structural determinants, few explicitly focused on their impact on minority health and health disparities. Rigorously evaluated, evidence-based structural interventions are needed to address multilevel structural determinants that systemically lead to and perpetuate social and health inequities. This article highlights examples of structural interventions that have yielded health benefits, discusses challenges and opportunities for accelerating improvements in minority health, and proposes recommendations to foster the development of structural interventions likely to advance health disparities research.

Enhancing Diversity and Productivity of the HIV Behavioral Research Workforce through Research Education Mentoring Programs

Mentoring programs to enhance diversity in the HIV research workforce, using the research education grant mechanism (R25), were addressed to promote new investigator development in HIV-related behavior and social sciences. The utility and benefits of the R25 mechanism were discussed. Outcome data from publication history and funded grants of mentees from the major racial and ethnic minority backgrounds indicated the success of these programs in promoting HIV-related career development. Next steps and future challenges were addressed for further enhancing the HIV research workforce.

Engaging Latina breast cancer survivors in research: building a social network research registry

Disparities persist in breast cancer outcomes between Latina survivors and non-Hispanic Whites. Identifying methods to ensure that Latinas participate in and benefit from translational behavioral medicine research is important to reduce disparities. We developed a "Social Network Research Registry" to enhance Latina survivors' engagement in research and explored the social networks and research/cancer organization participation in this population. We initially recruited 30 Latina breast cancer survivors ("seeds") from community organizations and identified other survivors through snowball sampling. Guided by Social Network Analysis, we assessed the structural (e.g., size) and functional (e.g., social support) characteristics of the network, willingness to join the registry, prior research participation, involvement in cancer organizations, and interest in different types of research and roles in research. The resulting network size was 98, including 53 women who enrolled in the study and 45 who were listed in the network but did not enroll. All enrolled participants (N = 53) agreed to be part of the registry. We identified 15 participants who occupied strategic positions as hubs and/or bridges. Women who were currently involved in cancer organizations were more likely to have participated in research (70.3% vs. 18.8%); χ2 (1, 53) = 11.97, p = .001. Most were interested in surveys/interviews (98%), behavioral interventions (96%), and becoming health promoters (79%). The Social Network Research Registry is an acceptable and feasible strategy to engage underrepresented Latina survivors in research. Social network analysis can be useful to identify members who occupy key positions to enhance recruitment and translational efforts.

The Inner Working of Trauma: A Qualitative Assessment of Experiences of Trauma, Intergenerational Family Dynamics, and Psychological Well-Being in Women With HIV in South Carolina

Women with HIV are more likely to have a history of traumatic and stressful life experiences. The current study examines experiences of traumatic and stressful life events, issues co-occurring with experiences of trauma, and intergenerational family dynamics regarding trauma and psychological well-being in women with HIV. The study was guided by the theoretical approach of an integrative translational model that incorporates trauma-related factors into a psychosocial framework. Data were collected from interviews with 20 women with HIV and analyzed for thematic categories. Thematic analysis indicated that traumatic life events of women with HIV included experiences of loss, sexual assault, and homelessness. Women with HIV also experienced issues co-occurring with trauma, including substance use and mental illness. The current study adds to the existing body of research by including an analysis of intergenerational family dynamics and psychological well-being. Implications for health care professionals and recommendations for translating research into practice are also discussed. [Journal of Psychosocial Nursing and Mental Health Services, 57(4), 23-31.].

Lessons Learned from Three Models that Use Small Grants for Building Academic-Community Partnerships for Research

Despite the direct contribution of community-engaged research towards effective translation, establishing strong and sustained community academic research partnerships remains a challenge. The Atlanta Clinical and Translational Science Institute's Community Engagement Research Program (CERP) has developed and implemented three models for using small grants to seed new community academic partnerships for research: 1) community-initiated health projects with faculty partners, 2) dissemination of discoveries to community partners, and 3) building collaborative research capacity. In this paper, we describe each model in terms of its purpose, funding level, funding period, proposal requirements, selection criteria and faculty involvement. Resulting partnerships are described, along with benefits and challenges from faculty and community perspectives, and lessons learned in using these mechanisms to promote community-engaged research. These models may aid others attempting to promote community-engaged research for the purpose of narrowing the gap between research, practice and ultimately, impact on community health.

Implementation of health promotion programmes in schools: an approach to understand the influence of contextual factors on the process?

BACKGROUND

Implementing complex and multi-level public health programmes is challenging in school settings. Discrepancies between expected and actual programme outcomes are often reported. Such discrepancies are due to complex interactions between contextual factors. Contextual factors relate to the setting, the community, in which implementation occurs, the stakeholders involved, and the characteristics of the programme itself. This work uses realist evaluation to understand how contextual factors influence the implementation process, to result in variable programme outcomes. This study focuses on identifying contextual factors, pinpointing combinations of contextual factors, and understanding interactions and effects of such factors and combinations on programme outcomes on different levels of the implementation process.

METHODS

Schools which had participated in a school-based health promotion programme between 2012 and 2015 were included. Two sets of qualitative data were collected: semi-structured interviews with school staff and programme coordinators; and written documents about the actions implemented in a selection of four schools. Quantitative data included 1553 questionnaires targeting pupils aged 8 to 11 in 14 schools to describe the different school contexts.

RESULTS

The comparison between what was expected from the programme (programme theory) and the outcomes identified in the field data, showed that some of the mechanisms expected to support the implementation of the programme, did not operate as anticipated (e.g. inclusion of training, initiation by decision-maker). Key factors which influenced the implementation process included, amongst other factors, the mode of introduction of the programme, home/school relationship, leadership of the management team, and the level of delegated power. Five types of interactions between contextual factors were put forward: enabling, hindering, neutral, counterbalancing and moderating effects. Recurrent combinations of factors were identified. Implementation was more challenging in vulnerable schools where school climate was poor.

CONCLUSION

A single programme cannot be suited or introduced in the same manner in every context. However, key recurrent combinations of contextual factors could contribute to the design of implementation patterns, which could provide guidelines and recommendation for grass-root programme implementation.

Enabling full representation in science: the San Francisco BUILD project's agents of change affirm science skills, belonging and community

Background

The underrepresentation of minority students in the sciences constrains innovation and productivity in the U.S. The SF BUILD project mission is to remove barriers to diversity by taking a "fix the institution" approach rather than a "fix the student" one. SF BUILD is transforming education, research, training, and mentoring at San Francisco State University, a premiere public university that primarily serves undergraduates and ethnic minority students. It boasts a large number of faculty members from underrepresented groups (URGs), including many of the project leaders. These leaders collaborate with faculty at the University of California San Francisco (UCSF), a world-class medical research institution, to implement SF BUILD.

Key highlights

Together, the campus partners are committed to creating intellectually safe and affirming environments grounded in the Signaling Affirmation for Equity (SAFE) model, which is based on robust psychosocial evidence on stereotype threat and its consequences. The SAFE model dictates a multilevel approach to increasing intent to pursue a biomedical career, persistence in STEM fields, and productivity (e.g. publications, presentations, and grants) by implementing transformative activities at the institutional, faculty, and student levels. These activities (1) increase knowledge of the stereotype threat phenomenon; (2) affirm communal and altruistic goals of students and faculty to "give back" to their communities in classrooms and research activities; and (3) establish communities of students, faculty and administrators as "agents of change." Agents of change are persons committed to establishing and maintaining SAFE environments. In this way, SF BUILD advances the national capacity to address biomedical questions relevant to communities of color by enabling full representation in science.

Implications

This chapter describes the theoretical and historical context that drive the activities, research and evaluation of the SF BUILD project, and highlights attributes that other institutions can use for institutional change. While this paper is grounded in psychosocial theory, it also provides practical solutions for broadening participation.

Introduction: Impacting the Social Determinants of Health through a Regional Academic-Community Partnership: The Experience of the Mid-South Transdisciplinary Collaborative Center for Health Disparities Research

Objective

The purpose of this article is to describe the background and experience of the Academic-Community Engagement (ACE) Core of the Mid-South Transdisciplinary Collaborative Center for Health Disparities Research (Mid-South TCC) in impacting the social determinants of health through the establishment and implementation of a regional academic-community partnership.

Conceptual Framework

The Mid-South TCC is informed by three strands of research: the social determinants of health, the socioecological model, and community-based participatory research (CBPR). Combined, these elements represent a science of engagement that has allowed us to use CBPR principles at a regional level to address the social determinants of health disparities.

Results

The ACE Core established state coalitions in each of our founding states-Alabama, Louisiana, and Mississippi-and an Expansion Coalition in Arkansas, Tennessee, and Kentucky. The ACE Core funded and supported a diversity of 15 community engaged projects at each level of the socioecological model in our six partner states through our community coalitions.

Conclusion

Through our cross-discipline, cross-regional infrastructure developed strategically over time, and led by the ACE Core, the Mid-South TCC has established an extensive infrastructure for accomplishing our overarching goal of investigating the social, economic, cultural, and environmental factors driving and sustaining health disparities in obesity and chronic illnesses, and developing and implementing interventions to ameliorate such disparities.

"Layers of translation" - evidence literacy in public health practice: a qualitative secondary analysis

BACKGROUND

Strengthening public health systems has been a concern in Canada in the wake of public health emergencies. In one Canadian province, British Columbia, a high priority has been placed on the role of evidence to guide decision making; however, there are numerous challenges to using evidence in practice. The National Collaborating Centre for Methods and Tools therefore developed the Evidence Informed Public Health Framework (EIPH), a seven step guide to assist public health practitioners to use evidence in practice. We used this framework to examine the evidence literacy of public health practitioners in BC.

METHODS

We conducted a secondary analysis of two separate qualitative studies on the public health renewal process in which the use and understanding of evidence were key interview questions. Using constant comparative analysis, we analyzed the evidence-related data, mapping it to the categories of the EIPH framework.

RESULTS

Participants require both data and evidence for multiple purposes in their daily work; data may be more important to them than research evidence. They are keen to provide evidence-based programs in which research evidence is balanced with community knowledge and local data. Practitioners recognise appraisal as an important step in using evidence, but the type of evidence most often used in daily practice does not easily lend itself to established methods for appraising research evidence. In the synthesis stage of the EIPH process, synthesized evidence in the form of systematic reviews and practice guidelines is emphasized. Participants, however, need to synthesize across the multiple forms of evidence they use and see the need for more skill and resources to help them develop skill in this type of synthesis.

CONCLUSIONS

Public health practitioners demonstrated a good level of evidence literacy, particularly at the collective level in the organization. The EIPH framework provides helpful guidance in how to use research evidence in practice, but it lacks support on appraising and synthesizing across the various types of evidence that practitioners consider essential in their practice. We can better support practitioners by appreciating the range of evidence they use and value and by creating tools that help them to do this.

From Discovery to Practice: Translating and Transforming Work-Family Research for the Health of Families

The aim of this paper is to examine the meaning of translational research in the work and family field. Specifically, we review findings from a longitudinal study of low-wage workers across the transition to parenthood and examine how this basic discovery research informs the next step in translational research, that of clinical practice. The authors describe three specific sets of findings that hold direct and immediate implications for interventions and policy that could support working families. The paper closes with a discussion of how both translational and transdisciplinary research have the potential to inform evidence-based practice, social policy, and effective social action to decrease physical and mental health disparities among low-income, working families.

A participatory evaluation framework in the establishment and implementation of transdisciplinary collaborative centers for health disparities research

OBJECTIVE

We describe the formulation and implementation of a participatory evaluation plan for three Transdisciplinary Collaborative Centers for Health Disparities Research funded by the National Institute of Minority Health and Health Disparities.

METHODS

Although different in scope of work, all three centers share a common goal of establishing sustainable centers in health disparities science in three priority areas - social determinants of health, men's health research, and health policy research.

RESULTS

The logic model guides the process, impact, and outcome evaluation. Emphasis is placed on process evaluation in order to establish a "blue print" that can guide other efforts as well as assure that activities are being implemented as planned.

CONCLUSION

We have learned three major lessons in this process: (1) Significant engagement, participation, and commitment of all involved is critical for the evaluation process; (2) Having a "roadmap" (logic model) and "directions" (evaluation worksheets) are instrumental in getting members from different backgrounds to follow the same path; and (3) Participation of the evaluator in the leadership and core meetings facilitates continuous feedback.

The ConNECT Framework: a model for advancing behavioral medicine science and practice to foster health equity

Health disparities persist despite ongoing efforts. Given the United States' rapidly changing demography and socio-cultural diversity, a paradigm shift in behavioral medicine is needed to advance research and interventions focused on health equity. This paper introduces the ConNECT Framework as a model to link the sciences of behavioral medicine and health equity with the goal of achieving equitable health and outcomes in the twenty-first century. We first evaluate the state of health equity efforts in behavioral medicine science and identify key opportunities to advance the field. We then discuss and present actionable recommendations related to ConNECT's five broad and synergistic principles: (1) Integrating Context; (2) Fostering a Norm of Inclusion; (3) Ensuring Equitable Diffusion of Innovations; (4) Harnessing Communication Technology; and (5) Prioritizing Specialized Training. The framework holds significant promise for furthering health equity and ushering in a new and refreshing era of behavioral medicine science and practice.

Informed Consent to Research with Cognitively Impaired Adults: Transdisciplinary Challenges and Opportunities

Due to issues related to informed research consent, older adults with cognitive impairments are often excluded from high-quality studies that are not directly related to cognitive impairment, which has led to a dearth of evidence for this population. The challenges to including cognitively impaired older adults in research and the implications of their exclusion are a transdisciplinary issue. The ethical challenges and logistical barriers to conducting research with cognitively impaired older adults are addressed from the perspectives of three different fields-social work, emergency medicine, and orthopaedic surgery. Issues related to funding, study design, intervention components, and outcomes are discussed through the unique experiences of three different providers. A fourth perspective-medical research ethics-provides alternatives to exclusion when conducting research with cognitively impaired older adults such as timing, corrective feedback and plain language, and capacity assessment and proxy appointments. Given the increasing aging population and the lack of evidence on cognitively impaired older adults, it is critical that researchers, funders, and institutional review boards not be dissuaded from including this population in research studies.

Future HIV Mentoring Programs to Enhance Diversity

This paper proposes a general template to guide future mentoring program development addressing: (i) considerations to ensure an adequate research workforce; (ii) key guidelines and principles of mentoring; and (iii) use of a logic model to develop program milestones, outcomes and evaluation. We focus on these areas to guide and inform the most effective mentoring program components, which we find to be more helpful than identifying specific features and ingredients. Although the focus is on the development of a new generation of investigators from diverse backgrounds, this template may also apply to mentoring programs for other investigators and for disciplines beyond HIV.

The Sangre Por Salud Biobank: Facilitating Genetic Research in an Underrepresented Latino Community

BACKGROUND/AIMS

The Sangre Por Salud (Blood for Health; SPS) Biobank was created for the purpose of expanding precision medicine research to include underrepresented Latino patients. It is the result of a unique collaboration between Mayo Clinic and Mountain Park Health Center, a federally qualified community health center in Phoenix, Arizona. This report describes the rationale, development, implementation, and characteristics of the SPS Biobank.

METHODS

Latino adults (ages 18-85 years) who were active patients within Mountain Park Health Center's internal medicine practice in Phoenix, Ariz., and had no history of diabetes were eligible. Participants provided a personal and family history of chronic disease, completed a sociodemographic, psychosocial, and behavioral questionnaire, underwent a comprehensive cardiometabolic risk assessment (anthropometrics, blood pressure and labs), and provided blood samples for banking. Laboratory results of cardiometabolic testing were returned to the participants and their providers through the electronic health record.

RESULTS

During the first 2 years of recruitment into the SPS Biobank, 2,335 patients were approached and 1,432 (61.3%) consented to participate; 1,354 (94.5%) ultimately completed all requisite questionnaires and medical evaluations. The cohort is primarily Spanish-speaking (72.9%), female (73.3%), with a mean age of 41.3 ± 12.5 years. Most participants were born outside of the US (77.9%) and do not have health insurance (77.5%). The prevalence of overweight (35.5%) and obesity (45.0%) was high, as was previously unidentified prediabetes (55.9%), type 2 diabetes (7.4%), prehypertension (46.8%), and hypertension (16.2%). The majority of participants rated their health as good to excellent (72.1%) and, as a whole, described their overall quality of life as high (7.9/10).

CONCLUSION

Collaborative efforts such as the SPS Biobank are critical for ensuring that underrepresented minority populations are included in precision medicine initiatives and biomedical research that seeks to improve human health and reduce the burdens of disease.

Engaging Pacific Islanders in Research: Community Recommendations

BACKGROUND

Health disparities continue to persist among Native Hawaiian and Pacific Islander (NHPI) communities.

OBJECTIVES

This study sought to understand the perspectives of community organizations in the Ulu Network on how researchers can collaborate with communities to promote community wellness.

METHODS

Key informant interviews and small group interviews were conducted with the leadership in the Ulu Network.

RESULTS

Five themes were identified that highlight the importance of investing time and commitment to build authentic relationships, understanding the diversity and unique differences across Pacific communities, ensuring that communities receive direct and meaningful benefits, understanding the organizational capacity, and initiating the dialog early to ensure that community perspectives are integrated in every stage of research.

CONCLUSIONS

Increasing capacity of researchers, as well as community organizations, can help build toward a more equitable and meaningful partnership to enhance community wellness.