Community Healthcare Professionals Research Articles

Abstract PO2-10-08: Contemporary HER2-Positive MBC Treatment Recommendations Among Community Healthcare Professionals: Analysis of an Online Interactive Decision Support Tool

Abstract Background: The management of HER2-positive (HER2+) metastatic breast cancer (MBC) has continued to evolve, with multiple FDA approvals of novel HER2-targeted agents since late 2019. Considering the growing HER2+ MBC treatment armamentarium, we sought to identify current practice patterns among community healthcare professionals (HCPs) for HER2+ MBC by comparing HCP and key opinion leader (KOL) treatment recommendations using an online decision support tool. Methods: An online decision support tool was developed with input from 5 KOLs to provide therapy recommendations for 630 HER2+ MBC patient case scenarios based on conventional considerations including distribution of metastatic disease, treatment history, duration of response, and specific comorbidities. HCP tool users entered specific patient criteria to define a case along with their intended management for each case. The tool then showed 5 KOL recommendations for the user-entered patient case, and the users were asked to indicate if the expert recommendations confirmed or changed their intended approach. An analysis of expert recommendations and user-selected therapy was performed. Results: Between November 2022 and July 2023, 313 patient cases were entered by 242 participating HCPs. HCP and KOL treatment recommendations were frequently discordant (Table). For patients with de novo HER2+ MBC (n = 55), there was strong concordance (63%; P = .0001) between HCP and KOL recommendations. However, weak treatment selection concordance (53%; P < .0001) was observed for patients with disease progression after standard neoadjuvant/adjuvant therapy with chemotherapy plus HER2-targeted agents (n = 57). In the second-line setting, 43% concordance was observed for patients with non‒central nervous system (CNS) disease progression without CNS progression after first-line therapy with THP (n = 67; P < .0001), whereas 61% concordance was observed for patients with non-CNS and CNS disease progression after first-line therapy with THP (n = 61; P < .0001). In the third-line setting, 31% concordance was observed for patients with non-CNS disease progression without CNS progression (n = 32; P < .0001), and 47% concordance was observed for patients with non-CNS and CNS disease progression (n = 19; P = .0009). For HCPs whose treatment plan did not match KOL recommendations in these scenarios, 62% indicated that KOL recommendations confirmed or changed their intended therapy, but 19% indicated that there were barriers to implementing those recommendations. Conclusions: These data suggest ongoing challenges to optimally incorporate novel HER2-targeted therapies in the care of patients with HER2+ MBC, particularly in the second line and beyond, but an online tool providing KOL advice on specific patient scenarios confirmed or changed the clinical approach for a majority of HCPs. Thus, continued development of resources for HCPs, including online decision support tools, may be increasingly important given the rapidly evolving treatment landscape. Table. Summary of Treatment Choices by KOLs or HCPs for Select Patient Scenarios Citation Format: Kristen Rosenthal, Sara Hurvitz, Komal Jhaveri, Heather McArthur, Sara Tolaney, Timothy Quill. Contemporary HER2-Positive MBC Treatment Recommendations Among Community Healthcare Professionals: Analysis of an Online Interactive Decision Support Tool [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-10-08.

Community support for families affected by dementia.

This paper provides and overview of the community support services that may be available for people with dementia and their family carers. The authors introduce dementia, including the impact of the diagnosis on both the person with dementia and the wider family. Using a case study approach, the authors describe the support available, spanning health and social care and third sector organisations. They discuss how this support can enable people with dementia and their carers to maintain wellbeing and cope with the impact of dementia. This article will be of interest to community nurses, and health and social care professionals more generally, who may encounter families affected by dementia in community settings. Having a good knowledge of the support available and how to access it will allow community nurses to capitalise on the health promotion opportunities presented to them, when they come into contact with families affected by dementia in the course of their day-to-day practice.

Abstract PO3-02-01: Educational Opportunities to Improve Community Healthcare Professionals’ Management of High-Risk HR-Positive/HER2-Negative Early Breast Cancer

Abstract Background: The treatment landscape for patients with hormone receptor–positive/HER2-negative early breast cancer (HR+/HER2- EBC) has evolved with the emergence of adjuvant CDK4/6 inhibitor therapy as a new option for patients with a high risk of disease recurrence. Adjuvant abemaciclib plus aromatase inhibitors (AIs) is guideline recommended for high clinical risk HR+ disease and reduces risk of recurrence regardless of Ki-67 expression level. Here, we examine healthcare professionals’ (HCPs’) awareness and practice regarding the use of adjuvant abemaciclib. Methods: Between November 2022 and June 2023, we conducted a series of regional educational activities for HCPs focused on management of high-risk HR+/HER2- EBC. Each activity included an interactive lecture led by a clinical investigator with expertise in managing patients with high-risk HR+/HER2- EBC and polling questions designed to assess key aspects of HCP knowledge and practice in the optimal management of high-risk HR+/HER2- EBC. A wider HCP audience was able to view an interactive on-demand webcast with the same content and embedded polling questions. Results: In total, 701 HCPs participated in one of 20 live (n = 373) activities or the one associated on-demand (n = 328) webcast. The distribution of HCP participation differed between the live and online activities with more physicians participating in the online activity vs the live activity (59% vs 34%, respectively); the converse was true for nurse participation (9% online vs 34% live). Polling result trends were similar between the live and online activities. At baseline, 38% (n/N = 182/405) of HCPs chose adjuvant therapy with an AI plus abemaciclib for a patient with high-risk, node-positive HR+/HER2- EBC consistent with expert and guideline recommendations. Following the education, 92% (n/N = 405/439) of HCPs selected AI plus abemaciclib for appropriate patients. Before education, 32% of HCPs (n/N = 147/454) were aware that adjuvant abemaciclib plus endocrine therapy improved invasive disease-free survival compared with endocrine therapy alone in patients with high-risk, node-positive HR+/HER2- EBC regardless of Ki-67 expression level, which increased to 87% (n/N = 370/425) following the education. Regarding the management of grade 2 neutropenia associated with adjuvant abemaciclib therapy, HCP knowledge was low at baseline (32%, n/N = 141/446) and improved to 80% (n/N = 332/415) after education. Conclusions: HCPs’ knowledge of and practice concerning adjuvant abemaciclib as a newer approved therapy for patients with high-risk HR+/HER2- EBC remain suboptimal. These results suggest an ongoing need for expert guidance and educational activities on the use of adjuvant abemaciclib therapy for appropriate patients with high-risk HR+/HER2- EBC. As the treatment landscape for HR+/HER2- EBC continues to evolve with the potential approval of additional new therapies, this need will only increase with a clear impact on optimizing and individualizing adjuvant therapy strategies for patients with HR+/HER2- EBC. Citation Format: Marie Becker, Timothy Quill, Erika Hamilton, Joyce O'Shaughnessy. Educational Opportunities to Improve Community Healthcare Professionals’ Management of High-Risk HR-Positive/HER2-Negative Early Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-02-01.

People who use drugs engagement in substance use disorder services and harm reduction: evaluation, challenges and future direction of a community-based intervention

BackgroundSince 1996, an urban community-based organization whose primary mission is to serve diverse94 and emerging community health needs has provided screening, testing, overdose prevention and training, referrals, and access to treatment for substance use disorders (SUD) and communicable diseases such as HIV through its Life Points harm reduction program.MethodsAs a partner in a State survey in 2021, the community organization recruited a convenience sample of people who use drugs to participate in a survey focused on their substance use, healthcare, and barriers to SUD services. Community health workers conducted outreach and used an encrypted identifier to collect data from a convenience sample of harm reduction participants regarding demographics, legal justice, engagement in harm reduction and access to healthcare. Evaluators entered paper surveys into Qualtrics for reporting and summative analysis.ResultsA convenience sample of fifty-five people who use drugs were recruited and surveyed. The majority (86%, n = 47) were active participants in the agency Life Points (LP) harm reduction service. Participants’ average age was 42.9 years (SD = 11.5). About half (51%, n = 28) were male, 48% (n = 26) were female, and 2% (n = 1) was transgender. About two-thirds (67%, n = 37) of participants were White/Caucasian, 13% (n = 7) were Black/African-American, 11% (n = 6) were Hispanic and 7% (n = 4) were Multi-Racial. Regarding current substance use, 98% (n = 54) reported use of heroin, 51% (n = 28) reported crack, 47% (n = 26) cocaine, 25% (n = 14) alcohol, 24% (n = 13) opioids, and 15% (n = 8) marijuana. The majority, 87% (n = 48) said they had health care insurance and over two-thirds (69%, n = 37) said they had been arrested for a felony. Almost three quarters (71%, n = 39) reported receiving services from the Department of Health & Human Services. A higher percentage of females compared to males (65% and 29% respectively) reported engagement in community mental health services and 69% of females (n = 18) compared to 15% (n = 4) of males reported needing to participate in sex to meet basic social needs. Participants described social determinants of health as barriers to services, including access to food, legal justice and transportation. About 44% (n = 24) said they would consider enrolling in a drug treatment program in the next 30 days.ConclusionThis sample was reflective of increased participation by White participants that began to appear about a decade ago. The majority of participants reported having healthcare insurance, which may be reflective of engagement with community health workers to access appropriate services. Community organizations and healthcare professionals should continue to explore social determinants of health that can impact the health of people who use drugs, including overcoming barriers to health care access such as investing in mobile unit outreach.

Intervention Strategies for Mitigating Drug and Substance Abuse Among Youths in Selected Local Government Areas of Benue State, Nigeria

This study investigated intervention strategies for reducing drug and substance abuse among youths in selected Local Government Areas (LGAs) of Benue State, Nigeria. The survey research design was employed in this study and qualitative data collection was made. Both primary and secondary data were collected through in-depth interviews conducted with key informants, including community leaders, parents, teachers, and healthcare professionals, to obtain qualitative insights into the underlying factors contributing to drug and substance use. The study adopted the qualitative data analysis which involved thematic and content analysis to identify key themes and patterns in the participants' narratives. Thematic and content analysis revealed various contributing factors to drug abuse and the distinct roles of key players in addressing the issue. Tailoring national campaigns to local contexts through domestication emerged as an effective approach, leveraging community engagement, local influencers, and continuous monitoring. The study emphasised the critical roles of the NDLEA, health practitioners, religious and traditional institutions, media, and NGOs in prevention efforts. The study discovers that various key players are identified, showcasing their distinct roles and responsibilities in addressing this pressing issue. The study showed that tailoring national campaigns to local contexts through domestication enhances effectiveness by customizing messages and interventions to the local culture of drug and substance abuse. The study recommended implementing comprehensive prevention programs, advocating for good parenting, strengthening law enforcement, and improving access to mental health services for affected youths. This study underscores the collective responsibility of stakeholders, including governmental agencies, community institutions, religious leaders, educators, parents, NGOs, and youths themselves, in addressing drug abuse among youths in Benue State. The study concludes that the significance of acknowledging drug abuse as a collective concern that requires the involvement of various stakeholders, including governmental agencies, community institutions, religious leaders, educators, parents, NGOs, and youths themselves. The prevalence of drug abuse among youths in the district underscores the need for immediate action and underscores the responsibility of each stakeholder to play a role in prevention, intervention, and rehabilitation efforts towards mitigating drug and substance abuse among youths in Benue State.

Effect of a Co-Located Bridging Recovery Initiative on Hospital Length of Stay Among Patients With Opioid Use Disorder

Co-located bridge clinics aim to facilitate a timely transition to outpatient care for inpatients with opioid use disorder (OUD); however, their effect on hospital length of stay (LOS) and postdischarge outcomes remains unclear. To evaluate the effect of a co-located bridge clinic on hospital LOS among inpatients with OUD. This parallel-group randomized clinical trial recruited 335 adult inpatients with OUD seen by an addiction consultation service and without an existing outpatient clinician to provide medication for OUD (MOUD) between November 25, 2019, and September 28, 2021, at a tertiary care hospital affiliated with a large academic medical center and its bridge clinic. The bridge clinic included enhanced case management before and after hospital discharge, MOUD prescription, and referral to a co-located bridge clinic. Usual care included MOUD prescription and referrals to community health care professionals who provided MOUD. The primary outcome was the index admission LOS. Secondary outcomes, assessed at 16 weeks, were linkage to health care professionals who provided MOUD, MOUD refills, same-center emergency department (ED) and hospital use, recurrent opioid use, quality of life (measured by the Schwartz Outcome Scale-10), overdose, mortality, and cost. Analysis was performed on an intent-to-treat basis. Of 335 participants recruited (167 randomized to the bridge clinic and 168 to usual care), the median age was 38.0 years (IQR, 31.9-45.7 years), and 194 (57.9%) were male. The median LOS did not differ between arms (adjusted odds ratio [AOR], 0.94 [95% CI, 0.65-1.37]; P = .74). At the 16-week follow-up, participants referred to the bridge clinic had fewer hospital-free days (AOR, 0.54 [95% CI, 0.32-0.92]), more readmissions (AOR, 2.17 [95% CI, 1.25-3.76]), and higher care costs (AOR, 2.25 [95% CI, 1.51-3.35]), with no differences in ED visits (AOR, 1.15 [95% CI, 0.68-1.94]) or deaths (AOR, 0.48 [95% CI, 0.08-2.72]) compared with those receiving usual care. Follow-up calls were completed for 88 participants (26.3%). Participants referred to the bridge clinic were more likely to receive linkage to health care professionals who provided MOUD (AOR, 2.37 [95% CI, 1.32-4.26]) and have more MOUD refills (AOR, 6.17 [95% CI, 3.69-10.30]) and less likely to experience an overdose (AOR, 0.11 [95% CI, 0.03-0.41]). This randomized clinical trial found that among inpatients with OUD, bridge clinic referrals did not improve hospital LOS. Referrals may improve outpatient metrics but with higher resource use and expenditure. Bending the cost curve may require broader community and regional partnerships. ClinicalTrials.gov Identifier: NCT04084392.

Empowering Riverine Communities in the Amazon: Strategies for Preventing Rabies.

Rabies, caused by the Lyssavirus genus, is a highly lethal zoonotic disease transmitted by animals such as bats and domestic and wild carnivores to humans, claiming nearly 100% of lives. In Brazil, recent evidence suggests an increasing role of bats in human deaths from rabies, particularly in the Amazon region. This neglected tropical disease disproportionately affects impoverished and vulnerable populations in rural areas, where approximately 80% of human cases are concentrated. This article presents research conducted in riverine communities of the Tapajós/Arapiuns Extractive Reserve in Brazil to combat rabies in September 2022. The study adopted a participatory and collaborative approach, involving community members, healthcare professionals, and educators. Prioritizing proactive interventions, the health team administered prophylactic vaccinations to 30 individuals residing in communities exposed to the Lyssavirus. Educational activities focused on dispelling myths and raising awareness about preventive measures, with 100% of individuals reporting prior doubts about the disease, emphasizing the essential nature of the clarification, especially regarding preventive aspects. This study underscores the importance of community involvement, personalized interventions, and ongoing education to effectively combat rabies. By reinforcing public health policies and promoting health education, we can empower communities to take proactive measures in rabies prevention, leading to a reduction in incidence and an improvement in quality of life.

Needs assessment for pharmacy program creation designed to serve minority Francophone populations in Canada

ObjectivesCurrent literature provides little insight into the need for French language pharmaceutical-services in Francophone minority settings in Canada. This study aims to understand the pharmaceutical care and services offered in French in Canada. It also aims to conduct a needs assessment in the context of curriculum development, by validating whether pharmaceutical needs are being met in Francophone minority settings in Canada. MethodsAn online survey was sent to community members and healthcare professionals. Respondents were asked to identify the perceived importance of pharmaceutical needs, and the degree to which they perceive these to be fulfilled in French and in English in their communities. Results113 community members and 109 healthcare professionals completed the survey. Most respondents were from Ontario (64.84%), Quebec (10.50%) or Atlantic provinces (10.05%). >95% of survey respondents identified that pharmaceutical needs assessed were of very high importance. The rate of pharmaceutical need fulfillment was lower in French than English across all pharmaceutical needs assessed. The greatest difference in rate of pharmaceutical need fulfillment was seen with "Having safe access to required medication". The perception of pharmaceutical needs being met was congruent between community members and healthcare professionals. ConclusionThese results confirm a lack of pharmaceutical needs being met in French in Canadian Francophone minority communities. There is a lack of French language services that limits the ability to receive care in one's own language. Pharmacy education in French may be an effective approach to improve pharmaceutical care services received in French in francophone minority communities.

A unique collaborative model providing supportive and self-advocacy tools to the rare disease community

The National Ehlers-Danlos Syndromes (EDS) service is a highly specialised NHS commissioned service for diagnosing and supporting people with a rare, monogenic type of EDS. The service consists of a team of medical specialists and genetic counsellors. The EDS service has strong ties with national and international EDS charities, and together they participate in working and strategy groups alongside patients and carers. Acquired funding for research means that the service contributes to international knowledge regarding diagnosis and management of rare, monogenic EDS types. As a result of being a highly specialised service, there are multiple points of contact with patients, providing frequent opportunities for feedback. Patient data, surveys and collaborative working have enabled the development not only of extensive information resources and self-advocacy tools for patients, but also guidelines for health care professionals on the best ways to support their rare disease patients. The main challenges faced by patients affected by rare disease and the importance of self-advocacy are discussed, with the highly specialised National EDS service and the patients seen in this service as an example. The recommendations from this unique collaborative model include eight specific domains of self-advocacy: increasing knowledge of rare disease, taking care of mental well-being, taking care of physical well-being including routine care, the development of good working relationships between patients and health care professionals, information accessibility, emergency preparedness, taking part in education and outreach, and involvement in research and feedback opportunities. The service aims to be an example of patient-centred innovation and progress, providing a patient-focused supportive model that can be adapted by the rare disease community and other health care professionals.

Diagnostic accuracy of a new case‐finding tool for dementia in primary care: The Brief Assessment of Impaired Cognition Questionnaire (BASIC‐Q)

AbstractBackgroundThe aim of the project was to examine the diagnostic accuracy of BASIC‐Q (Brief Assessment of Impaired Cognition Questionnaire), a questionnaire‐based tool for detection of dementia in a community setting. Community health care professionals often see citizens who are older and therefore in risk of developing dementia or having undetected dementia. BASIC‐Q is an easy and quick (≤5 min) conversation‐based tool to be used to support community health care professionals when observing signs of dementia.MethodThe project has been carried out in collaboration with 14 general practices in Denmark in the period October 2021‐October 2022. Patients ≥ 70 years with appointment in the clinic for any given reason, were invited to participate in the study. The general practitioner or the nurse at the clinic administered BASIC‐Q ‐ consisting of four questions about orientation and three questions regarding the participants memory for both the participant and a close relative. Subsequently the participant participated in a structured telephone interview and an extended cognitive testing. Among other, the extended testing consisted of RBANS (Repeatable Battery for the Assessment of Neuropsychological Status) that together with an IADL‐evaluation (instrumental activities of daily living) and GDS‐15 (15‐item geriatric depression scale) was used as gold standard for classification of cognitive status when analyzing the sensitivity, specificity, and diagnostic accuracy of BASIC‐Q.ResultThe mean age of the total of 275 participants was 77.7 years, of which 148 were women (52.9%) and 127 were men (46.1%). Of the participants 142 (51.6%) showed no evidence of cognitive impairment, 33 (12%) showed evidence of affective disorder, and 82 (29.8%) showed indications of cognitive impairment. 18 participants (6.5%) could not be classified and were not included in the analyses.ConclusionBASIC‐Q is a quantifiable indicator of cognitive function. BASIC‐Q can be used as an assistive tool when health care professionals observe signs of dementia and need to decide whether to intervene.Preliminary analyses indicate that BASIC‐Q is a reliable tool for the detection of possible dementia in primary health care. The analyses of results are still ongoing and more results regarding the BASIC‐Q’s diagnostic accuracy will follow.

Dementia care practices among community healthcare workers in Vietnam: a qualitative descriptive study

BackgroundVietnam is one of the most rapidly aging countries in the world and the likelihood that someone may have dementia rises dramatically as the population ages. Although caring for persons living with dementia is important, little is known about the circumstances under which community healthcare professionals in Vietnam provide dementia care. This study aimed to describe the practice of caring for persons with dementia among community healthcare professionals in Vietnam.MethodsThis qualitative descriptive study was conducted with 23 community healthcare professionals recruited from 10 primary healthcare centers, representing 10 of 24 districts in Ho Chi Minh City, Vietnam. Participants were physicians (n = 11), physician’s assistants (n = 8) and community nurses (n = 4). Data were collected through in-depth face-to-face semi-structured interviews. Interview data were audio recorded, transcribed verbatim, and analyzed using content analysis.ResultsThe mean age of the 23 participants was 44.6 ± 8.8 years; most were female (n = 16, 69.6%); and the mean time of working in the field of dementia care was 15.9 ± 8.4 years. Analysis of the interview data revealed five categories, which informed how care was provided: 1) Knowledge about dementia and its prevalence among older adults; 2) Identification of dementia in Vietnam; 3) Lack of attention to early diagnosis of dementia and difficulty in providing continuous care; 4) Dependence on family members for prompt and continuous care; and 5) challenges to providing dementia care. Despite having knowledge about dementia, some healthcare professionals incorrectly viewed dementia as an inevitable part of the ageing process. Participants reported that their limited training and practical experience in caring for persons with dementia caused a lack of confidence in dementia care.ConclusionsThe quality of care provided to persons living with dementia was negatively impacted by the limited training of healthcare personnel. The diagnosis, treatment, and provision of supportive services to persons living with dementia and their families are substantial challenges for the Vietnamese healthcare system. It is crucial to initiate and cultivate dementia care education programs aimed at expanding curricula for physicians, physicians’ assistants, and nurses.

Finding a way forward with the community: qualitative inquiry in the generalized HIV epidemic in Mizoram, India.

Mizoram, the northeastern State of India bordering Myanmar, is presently witnessing a burgeoning generalized HIV epidemic along with the highest State-level HIV prevalence among female sex workers (FSWs, 24.7%) and people who inject drugs (PWID,19.8%) in the country. The present study was conducted against such background to understand the current situation of HIV prevention and care services in Mizoram, and capture community voices as well as concerns so that the way forward could be informed appropriately. The study period was October through December 2020 (in the midst of COVID-restrictions) in the districts of Aizawl, Mamit, Kolasib, Lunglei, and Champhai where HIV prevalence crossed 1% among ante-natal clinic (ANC) attending women. Contrastingly, the national average HIV prevalence among ANC attendees is 0.24%, which formed the basis for selecting the aforementioned five high burden districts for this current inquiry. In-depth-interviews were conducted with community members and youth leaders, vulnerable and general population groups as well as HIV-program officials. Interviews were recorded, transcribed, translated and later coded for analysis following thematic approach. The emerging issues were grouped in three thematic layers; (1) HIV vulnerability, (2) challenges pertaining to prevention and care services, and (3) program elements and future roadmap. Discrimination at the community level, unfriendly behavior of some of the HIV-service staff, occasional interruption in supplies of anti-retroviral treatment and sterile syringes and needles were voiced as deterrents to accessing HIV prevention and care services by the participants. Community engagement, based on restorative approach rather than retribution and ensuring enhanced performance of the district AIDS program control units emerged as necessary programmatic elements. This inquiry highlighted macro-social and structural forces contributing to stigma and discrimination toward people at risk of HIV. It is urgent that HIV-services are re-aligned through de-centralized district level innovations and creation of safer spaces at the physical, societal and familial level. These, even during the time of stress such as a pandemic, would help health services to remain resilient. HIV outreach, sensitization of the community leaders and health-care professionals through strategic communication and ownership of the communities in these endeavors appeared paramount.

Indigenous Women and Their Nutrition During Pregnancy (the Mums and Bubs Deadly Diets Project): Protocol for a Co-designed mHealth Resource Development Study.

Nutrition in pregnancy is pivotal to optimizing infant growth and maternal well-being. The factors affecting Indigenous people's food and nutrition intake are complex with a history of colonization impacting the disproportionate effect of social determinants to this day. Literature regarding the dietary intake or dietary priorities of Indigenous women in Australia is scarce, with supportive, culturally appropriate resources developed for and with this group rare. Research suggests mobile health (mHealth) tools are effective in supporting health knowledge of Indigenous people and positive health behavior changes when designed and developed with the expertise of Indigenous communities. This study seeks to build the body of knowledge related to nutrition needs and priorities for Indigenous women in Australia during pregnancy. Further, this project team and its participants will co-design an mHealth digital tool to support these nutrition needs. The Mums and Bubs Deadly Diets study recruits Indigenous women and health care professionals who support Indigenous women during pregnancy into 2 phases. Phase 1 (predesign) uses a mixed methods convergent design using a biographical questionnaire and social or focus groups to inform phase 2 (generative). Phase 2 will use a participatory action research process during co-design workshops to iteratively develop the digital tool; the exact actions within a workshop will evolve according to the participant group decisions. To date, this project has undertaken phase 1 focus groups at all Queensland sites, with New South Wales and Western Australia to begin in early to mid-2023. We have recruited 12 participants from Galangoor Duwalami, 18 participants from Carbal in Toowoomba, and 18 participants from Carbal in Warwick. We are expecting similar numbers of recruits in Western Australia and New South Wales. Participants have been both community members and health care professionals. This study is an iterative and adaptive research program that endeavors to develop real-world, impactful resources to support the nutrition needs and priorities of pregnant Indigenous women in Australia. This comprehensive project requires a combination of methods and methodologies to ensure Indigenous voices are heard at each stage and in all aspects of research output. The development of an mHealth resource for this cohort will provide a necessary bridge where there is often a gap in access to nutrition resources for women in pregnancy in Indigenous communities. DERR1-10.2196/45983.

Heart Health Begins With Community: Community-Based Research Exploring Innovative Strategies to Support First Nations Heart Health

BackgroundIndigenous people have displayed their strength through their holistic practices and spiritual connection to the land. Despite overcoming the impact of discriminatory and disempowering policies within Western institutions, Indigenous people continue to experience a higher risk of cardiovascular disease, compared to the general population. To move toward improving Indigenous health outcomes, researchers need to work in partnership with communities to develop heart health strategies centred on their experienced barriers and sources of healing. We conducted a community-based explorative study in Moosonee, Ontario to explore the local community’s needs and priorities regarding heart health and wellness. MethodsA convenience sample of community members and healthcare professionals were invited to participate in a sharing circle. Qualitative data were analyzed using conventional content analysis and the Indigenous method of two-eyed seeing. ResultsEight community members and 5 healthcare professionals participated in the sharing circle. Four dominant themes were identified: (1) heart health is more than metrics; (2) honouring our traumas; (3) destigmatizing care through relationship building; and (4) innovative solutions start with community. With the history of mistreatment among Indigenous people, strength-based solutions involved rebuilding clinical relationships. To bring care closer to home, digital health tools were widely accepted, but the design of these tools needs to integrate both Western and Indigenous approaches to healing. ConclusionsIndigenous health upholds the physical, emotional, psychological, and spiritual needs of an individual as being of equal importance. To improve community heart health, strategies should start by strengthening broken bonds and bridging multiple worldviews of healing.

Supported self-management for all with musculoskeletal pain: an inclusive approach to intervention development: the EASIER study

BackgroundSupported self-management interventions for patients with musculoskeletal (MSK) conditions may not adequately support those with limited health literacy, leading to inequalities in care and variable outcomes. The aim of this study was to develop a model for inclusive supported self-management intervention(s) for MSK pain that take account of health literacy.MethodsA mixed methods study with four work-packages was conducted: work package 1: secondary analysis of existing data to identify potential targets for intervention; work package 2: evidence synthesis to assess effective components of self-management interventions taking into account health literacy; work package 3: views of community members and healthcare professionals (HCPs) on essential components; work package 4: triangulation of findings and an online modified Delphi approach to reach consensus on key components of a logic model.FindingsFindings identified targets for intervention as self-efficacy, illness perceptions, and pain catastrophizing. A range of intervention components were identified (e.g. information in diverse formats offered at specific times, action planning and visual demonstrations of exercise). Support should be multi-professional using a combination of delivery modes (e.g. remote, face-to-face).ConclusionsThis research has developed a patient-centred model for a multi-disciplinary, multi-modal approach to supported self-management for patients with MSK pain and varying levels of health literacy. The model is evidence-based and acceptable to both patients and HCPs, with potential for significant impact on the management of MSK pain and for improving patient health outcomes. Further work is needed to establish its efficacy.

The Development of a Chatbot Technology to Disseminate Post-COVID-19 Information: Descriptive Implementation Study.

Post-COVID-19, or long COVID, has now affected millions of individuals, resulting in fatigue, neurocognitive symptoms, and an impact on daily life. The uncertainty of knowledge around this condition, including its overall prevalence, pathophysiology, and management, along with the growing numbers of affected individuals, has created an essential need for information and disease management. This has become even more critical in a time of abundant online misinformation and potential misleading of patients and health care professionals. The RAFAEL platform is an ecosystem created to address the information about and management of post-COVID-19, integrating online information, webinars, and chatbot technology to answer a large number of individuals in a time- and resource-limited setting. This paper describes the development and deployment of the RAFAEL platform and chatbot in addressing post-COVID-19 in children and adults. The RAFAEL study took place in Geneva, Switzerland. The RAFAEL platform and chatbot were made available online, and all users were considered participants of this study. The development phase started in December 2020 and included developing the concept, the backend, and the frontend, as well as beta testing. The specific strategy behind the RAFAEL chatbot balanced an accessible interactive approach with medical safety, aiming to relay correct and verified information for the management of post-COVID-19. Development was followed by deployment with the establishment of partnerships and communication strategies in the French-speaking world. The use of the chatbot and the answers provided were continuously monitored by community moderators and health care professionals, creating a safe fallback for users. To date, the RAFAEL chatbot has had 30,488 interactions, with an 79.6% (6417/8061) matching rate and a 73.2% (n=1795) positive feedback rate out of the 2451 users who provided feedback. Overall, 5807 unique users interacted with the chatbot, with 5.1 interactions per user, on average, and 8061 stories triggered. The use of the RAFAEL chatbot and platform was additionally driven by the monthly thematic webinars as well as communication campaigns, with an average of 250 participants at each webinar. User queries included questions about post-COVID-19 symptoms (n=5612, 69.2%), of which fatigue was the most predominant query (n=1255, 22.4%) in symptoms-related stories. Additional queries included questions about consultations (n=598, 7.4%), treatment (n=527, 6.5%), and general information (n=510, 6.3%). The RAFAEL chatbot is, to the best of our knowledge, the first chatbot developed to address post-COVID-19 in children and adults. Its innovation lies in the use of a scalable tool to disseminate verified information in a time- and resource-limited environment. Additionally, the use of machine learning could help professionals gain knowledge about a new condition, while concomitantly addressing patients' concerns. Lessons learned from the RAFAEL chatbot will further encourage a participative approach to learning and could potentially be applied to other chronic conditions.

Indigenous birth support worker (IBSW) program evaluation: a qualitative analysis of program workers and clients’ perspectives

BackgroundThe Indigenous Birth Support Worker (IBSW) Program provides Indigenous women with respectful, culturally safe, and trauma-informed care and supports women and families during labor and delivery. Located in the Jim Pattison Children’s Hospital (JPCH) Maternal Care Centre in Saskatoon, Saskatchewan, Canada, the program served 1023 clients between December 2019 and January 2021.MethodsThe study objective was to explore the perspectives of the IBSWs and program clients one year post-implementation. The research plan was developed in collaboration with the IBSW program director and manager, IBSWs, and partners from the First Nation and Métis Health departments within the health region. A focus group with four IBSWs and individual interviews with ten clients who received services were conducted using a qualitative research design.ResultsThematic analysis revealed that clients greatly appreciated and respected the IBSWs’ cultural support and their compassionate, nonjudgmental, and safe care. IBSWs emphasized the importance of culturally safe and client-centered treatment, more effective pain management solutions, and that relationships with Elders and community healthcare personnel should be built and strengthened to improve pregnancy and postnatal care delivery. IBSWs desire to work with community healthcare providers to provide prenatal care and build relationships before delivery. IBSWs advocated for collaborative cooperation with community healthcare professionals and rural healthcare teams to enable a smooth care flow to and from communities.ConclusionThe Indigenous Birth Support Worker (IBSW) Program provides safe and client-centred care to Indigenous women during pregnancy, labour, and postpartum, consistent with the six principles proposed by BC perinatal services. IBSWs advocate for and assist Indigenous women in obtaining quality healthcare, provide traditional and cultural support, and positively affect mental health. However, the evaluation has revealed that healthcare provider insensitivity towards Indigenous clients persists. There is a need for greater role clarity and collaboration with healthcare practitioners to ensure evidence-based healthcare of the highest standard. This requires a commitment to addressing systemic issues and implementing broader calls to action and justice proposed by the Truth and Reconciliation Commission Calls to Action, the Missing and Murdered Indigenous Women and Girls Calls for Justice, and the United Nations Declaration on the Rights of Indigenous Peoples. The IBSW program offers vital support to Indigenous women during childbirth, but it must be viewed in the context of ongoing colonialism and the need for reconciliation and decolonization, requiring genuine collaboration with Indigenous peoples.

Promoting health and preventing malnutrition among children in rural Bangladesh: A qualitative study.

To describe community healthcare professionals' experiences of preventing malnutrition among children in rural Bangladesh. A descriptive qualitative study with a total of seven healthcare professionals were recruited from a non-governmental organisation in rural Bangladesh. Individual in-depth interviews were conducted in November 2018 using a semi-structured interview guide. The audio-recorded interviews were transcribed verbatim and analysed manually using content analysis. The data analysis resulted in two main categories: Implementation and practices in preventing malnutrition and Challenges in working with prevention of malnutrition. Education was considered an important and essential preventative intervention. Healthcare professionals faced challenges in their work in relation to socio-cultural and climate factors. The findings indicate how healthcare professional identified the need for increased knowledge and resources in the community to promote nutritional health in children.

The role of community healthcare professionals in discussing sexual assault experiences during obstetrics and gynecological healthcare appointments

BackgroundNearly half of adult women in the US report experiencing sexual assault, with almost one-fifth reporting rape. For many sexual assault survivors, healthcare professionals are the first point of contact and disclosure. This study aimed to understand how healthcare professionals working in community settings perceived their role in discussing sexual violence experiences with women during obstetrical and gynecological healthcare appointments. The secondary purpose was to compare healthcare professionals’ perspectives with the patients’ to determine how sexual violence conversations should occur in these environments.MethodsData were collected in two phases. Phase 1 consisted of 6 focus groups (Sept-Dec, 2019) with women aged 18–45 (n = 22) living in Indiana who sought community-based or private healthcare for women’s reproductive healthcare needs. Phase 2 included 20 key-informant interviews with non-physician healthcare professionals (i.e., NP, RN, CNM, doula, pharmacist, chiropractor) living in Indiana (September 2019-May 2020) who provided community-based women’s reproductive healthcare. Focus groups and interviews were audio-recorded, transcribed, and analyzed using thematic analyses. HyperRESEARCH assisted in data management and organization.ResultsThere were three resulting themes: (1) healthcare professionals’ approaches to screening for a history of sexual violence varied depending on how they ask, what setting they work in, and type of professional asking; (2) healthcare experiences can compound traumatic experiences and create distrust with survivors; and (3) sexual violence impacts patient healthcare experiences through what services they seek, how professionals may interact with them, and what professionals they are willing to utilize.ConclusionsFindings offered insight into actionable and practical strategies for enhancing sexual violence screening and discussions in community-based women’s reproductive health settings. The findings offer strategies to address barriers and facilitators among community healthcare professionals and the people they serve. Incorporating healthcare professional and patient experiences and preferences for violence-related discussions during obstetrical and gynecological healthcare appointments can assist in violence prevention efforts, improve patient-professional rapport, and yield better health outcomes.

Abstract P1-08-07: Educational Opportunities to Improve HER2 Testing and Use of Newer Therapies for HER2-Positive MBC Among Community Healthcare Professionals

Abstract Background: The management of HER2-positive (HER2+) metastatic breast cancer (MBC) has continued to evolve, with multiple FDA approvals of novel HER2-targeted agents since late 2019. Considering the growing HER2+ MBC treatment armamentarium and the emerging HER2-low MBC subtype, we undertook an analysis of the current implementation of guideline and expert recommendations for HER2 testing and treatment of HER2+ MBC with recently approved agents among oncology healthcare professionals (HCPs) participating in educational programs on these topics. Methods: Between January 2020 and April 2022, we conducted several expert-designed educational activities for HCPs focusing on recommended HER2 testing and treatment of HER2+ MBC. Polling questions on HCP knowledge, practice patterns, and confidence in the evaluation of HER2 status and the use of newer targeted therapies in the setting of HER2+ MBC were assessed across the activities and compared with expert recommendations. Results: Among 129 HCPs participating in 2 educational activities held from July 2020 to March 2021, 53% reported confidence to appropriately apply current HER2 testing guidelines to patient care. Similarly, among 407 HCPs who participated in 4 educational programs from May 2020 to January 2021, 24% reported confidence to incorporate recently approved drugs (including trastuzumab deruxtecan [T-DXd], neratinib, and tucatinib) into the care of patients with HER2+ MBC. The percentage of HCPs reporting confidence in the use of these new drugs remained low over this time period. Comparison of treatment recommendations for various HER2+ MBC case scenarios across 7 educational activities from January 2020 through April 2022 showed considerable discordance between experts and HCPs regarding the implementation of newly approved HER2-targeted regimens (Table 1). For patients with disease progression after 2 lines of therapy and no central nervous system (CNS) metastases, 27% to 57% of HCPs (n = 571) chose T-DXd in agreement with experts. For patients with disease progression after 2 lines of therapy with CNS metastases, 27% to 42% of HCPs (n = 597) chose a tucatinib-based regimen in agreement with experts. Treatment choice concurrence between HCPs and experts did not increase over the course of this study for either of these patient scenarios. Conclusions: These data suggest that some HCPs are challenged to optimally incorporate recommendations for HER2 testing and the implementation of novel HER2-targeted therapies in the care of patients with HER2+ MBC. Educational activities designed to improve the knowledge and confidence of HCPs would benefit patients with HER2+ MBC. A detailed analysis of trends over time and by role on the care team will be presented. Table 1. Expert and HCP Treatment Selections for Case Scenarios in HER2+ MBC. Citation Format: Ryan P. Topping, Rachael M. Andrie, Kristen Rosenthal, Timothy A. Quill. Educational Opportunities to Improve HER2 Testing and Use of Newer Therapies for HER2-Positive MBC Among Community Healthcare Professionals [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-08-07.