Intervention Planning Research Articles

Development of Children's Perceived Nursing Image Scale: A Validity and Reliability Study.

Professional knowledge and awareness of children begins to create at the age of 3-5, and the professional knowledge have acquired at this age was effective in their future career decision-making. This study aimed to develop the Children's Perceived Nursing Image Scale (CPNIS) and evaluate its psychometric properties. The methodological study was carried out in a cross-sectional, descriptive, and correlational design. This study was conducted with 614 children aged 8-11 between 21 January-April 2022. The data were collected using a Child Information Form and the CPNIS. The CPNIS is a scale compatible with the deductive approach. The data were analysed using various statistical methods including descriptive statistics (numbers and percentages), t-tests, factor analysis, and correlation analysis. Item-total score analysis, the Intraclass Correlation Coefficient (ICC), and the internal consistency were employed to evaluate the reliability of the measurements. Three-stage cross-sectional study, which followed the STROBE checklist was conducted: (1) development of items, (2) assessing content validity and (3) validity and reliability of the scale. The CPNIS is a valid scale consisting of four factors as subdimensions. The total Cronbach's alpha of the scale is 0.93. The scale explained 46.4% of the total variance. The scale Test-Retest analysis, the total ICC value of the scale was found to be 0.84 and p = 0.001. Evaluation of the children's perceived nursing image can contribute to the identification of children with negative perceptions in clinics and the planning of interventions that will lead to positive perceptions.

Enhanced Advance care planning and life Review Longitudinal Intervention (EARLI): Protocol for a cluster randomized controlled cross-over trial of life story work and facilitated advance care planning among older Australian adults in community settings.

Advance care planning (ACP) is potentially helpful for older adults, however, the rate of uptake in community aged care settings is low. Previous pilot studies suggest that holistic, person-centered ACP approaches may be effective for older adults who experience functional impairment but do not necessarily have life-limiting conditions with clear prognoses. This paper describes the protocol of a randomized trial to test the effectiveness of combined life story work and facilitated ACP in promoting ACP engagement among older adults receiving community aged care services. The Enhanced Advance care planning and life Review Longitudinal Intervention (EARLI) trial is an open-label, cross-over, cluster randomized controlled trial with 12 participating aged care organizations in New South Wales and Western Australia. Participants are aged 65 years or older, receiving home care services and capable of providing informed consent at initial recruitment. Recruitment occurs across a two-year period, with study sites randomized to receive the four-session intervention in the first or second year (or a single session 'active control' condition). Primary outcomes are participant-reported ACP engagement and ACP documentation in the aged care client record 12 weeks post-recruitment. Secondary outcomes include measures of decisional conflict, anxiety and depression, meaning-based coping and relationship quality. Analysis will take an intention-to-treat approach. This trial tests a novel method of reaching older adults using a holistic, person-centered approach to promoting ACP engagement. Enhancing ACP engagement may reduce decisional conflict, minimize hospital admissions and improve outcomes for people and their families. ANZCTR Trial Registration ID: ACTRN12622001399785.

Prevalence and determinants of unintentional injuries and violence among high school students in Turkey: A cross-sectional study.

Injuries and violence are among the most prominent public health problems in the world. As well as being a leading cause of mortality - particularly among children and young adults - many of the millions of non-fatal injuries result in life-long disabilities and health consequences. The aim of this study was to estimate the prevalence of unintentional injuries and violence, and their associated factors among high school students. This cross-sectional study included a total of 1218 high-school students in Turkey. Data were collected through a facilitated self-administered questionnaire with questions adapted from the Global School-based Student Health Survey instrument. Data were analyzed in IBM SPSS Statistics 28.0 using chi-square test to find statistical significance if any. The significant variables from the chi-square test were selected for multiple logistic regression analysis. The overall prevalence of physical attack, physical fighting, and serious injuries were 8.3 %, 14.8 %, and 11.7 %, respectively. In a multiple regression analysis, student truancy and lateness, worry, suicide attempts, and not having close friends were found to be associated with physically attacked, physical fight, and serious injuries. This study demonstrated that the prevalence of unintentional injuries and violence among high school students is a major public health problem in Turkey. This study results can have important implications for school administration, parents, and policymakers alike to plan appropriate anti-violence strategies and interventions.

Danish parents' vaccination readiness is associated with their children's officially registered vaccination history.

Previous research has shown that parents' vaccination readiness, as measured by the 7C vaccination readiness scale, helps to understand whether and why parents are (not) willing to vaccinate their children. However, there is a lack of research investigating the association between parents' vaccination readiness and their children's actual vaccine uptake. Addressing this gap, we examined how Danish parents' level of vaccination readiness is associated with their child's vaccination status combining survey with official registry data. Specifically, parents residing in Denmark (N=2941, 64% female) completed a survey assessing their level of vaccination readiness with the 7C vaccination readiness scale for parents, trust in different sources of information on vaccination, and certainty about vaccinating their child with the next vaccine in the program. Additionally, official vaccination registry data on various recommended child vaccinations was obtained and matched to the survey data of their parents. Results from logistic regression analyses indicate that parents' readiness to vaccinate their children was substantially associated with completion of children's vaccination doses. More precisely, a one-point increase in parents' vaccination readiness score was associated with a two-fold increase in the likelihood of the child being vaccinated with the three main vaccines in the program. The results also show associations between each of the 7C factors, trust items, and demographic variables with real behavior as well as parents' certainty to vaccinate their children in the future. The findings further substantiate the usefulness of assessing parental vaccination readiness, with potential implications for intervention planning by researchers and policymakers.

Assessing sign language comprehension in adults with intellectual disability and deafness.

Language comprehension is an essential component of human development that is associated not only with expressive language development and knowledge acquisition, but also with social inclusion, mental health, and quality of life. For deaf and hard-of-hearing adults with intellectual disability, there is a paucity of measures of receptive sign language skills, although these are a prerequisite for individualized planning and evaluation of intervention. Assessments require materials and procedures that are accurate, feasible, and suitable for low levels of functioning. We adapted measures of English-language comprehension in young children-a direct assessment and a caregiver questionnaire-into Austrian Sign Language and to the target group of adults with intellectual disability and used them with a non-preselected sample of 67 deaf and hard-of-hearing adults with intellectual disability living in therapeutic communities specifically for deaf and hard-of-hearing people with multiple disabilities in Austria. Findings for both assessments demonstrate their construct validity, excellent internal consistency, and a large symmetrical distribution over the referential age range. Acceptance by the deaf and hard-of-hearing individuals and the caregivers and time-efficient administration suggest high practicability. We recommend further implementation in clinical practice, albeit with cautious interpretation of the results, and the inclusion of the instruments in research on intellectual disability and deafness.

Optimizing Workplace Violence Reporting in a Multisite Hospital Setting: A Quality Improvement Initiative.

Workplace violence (WPV) is a significant concern in healthcare settings and indicates the need for accurate reporting to plan and implement effective interventions. This article presents the results of a quality improvement (QI) initiative implemented at a large academic health sciences center to improve the reporting of WPV events. The Plan-Do-Study-Act (PDSA) model was adopted to optimize the electronic reporting process, reduce inaccuracies of WPV reporting, and ensure appropriate follow-up from leadership and the Workplace Health, Safety, and Wellness (WHSW) team. Over two PDSA cycles, modifications of an electronic incident reporting form were made. The proportion of inaccurate reporting was significantly lower (χ2 (1, N = 1,219) = 111.86, p = .001), after the QI initiative. In addition, the revisions increased staff follow-up and support from WHSW. Our QI initiative demonstrated that simple adjustments to our WPV reporting, with the revision of an electronic reporting form, had a significant improvement on incident data accuracy and staff follow-up. These findings will contribute to our organization's staff and patient safety.

Evaluating handgrip strength and functional tests as indicators of gait speed in older females

IntroductionWith aging, females often experience greater declines in functional capacity [e.g., gait speed (GS)] compared to males, highlighting the need for sex-difference considered in screening and intervention planning. In certain contexts, assessing GS may not be feasible. Handgrip strength (HGS) commonly used as a surrogate measure for physical performance, also serves as an indirect indicator of muscle strength in the lower limbs. This cross-sectional study aims to investigate the associations between HGS and common functional tests and to determine the optimal cut-off values for these tests in assessing GS.Methods142 community-dwelling older females aged 60–80 years old (mean age: 75 ± 6 years) were evaluated with HGS, the 30-second arm curl (30 s-AC), 30-second chair stand (30 s-CS), the Short Physical Performance Battery (SPPB), and the 8-foot Up & Go (8-UG) test. Pearson's correlation (r) was used to assess the strength of associations between HGS and functional variables, while multiple linear regression models identified determinants of GS. Receiver operating characteristic (ROC) curves were employed to evaluate the effectiveness of various tests in detecting slow GS (<1.0 m/s), by means of the area under the curve (AUC), sensitivity, and specificity.ResultsHGS showed positive significant (p < 0.001) associations with 30 s-AC (r = 0.499), SPPB (r = 0.447), and 30 s-CS (r = 0.329). Standardised coefficients of the linear models were: 30 s-AC (β=0.593), 30 s-CS (β=0.513), 5-CS (β=−0.431), and HGS (β=0.475) (all p < 0.001). ROC analysis revealed the following results: 30 s-AC (AUC = 0.80, cut-off=∼16 repetitions, sensitivity 83%, specificity 36%), 30 s-CS (AUC = 0.74; cut-off=∼13 repetitions, sensitivity 78%, specificity 64%), and 5-CS (AUC = 0.75, cut-off = 10.0 s, sensitivity 81%, specificity 57%), HGS (AUC = 0.73, cut-off=∼20 kg, sensitivity 79%, specificity 46%).DiscussionWe found that HGS was moderately-to-weakly associated with functional outcomes in older females, indicating that it may not reflect the overall body functional capacity. Despite similar AUCs across all tests, the 30 s-CS and 5-CS showed a better balance of sensitivity and specificity, making them potential indicators of slow GS compared to HGS and 30 s-AC.

ATUAÇÃO DO ENFERMEIRO NO CUIDADO AO PACIENTE DE TUBERCULOSE: REVISÃO DE LITERATURA

The National Program for Tuberculosis Control aims to promote, evaluate and carry out prevention, guaranteeing the treatment to the end. Nursing plays a fundamental role in promoting health, in prevention and early diagnosis and through health education that can make the person with tuberculosis aware of the disease and its treatment. It aims to gather and synthesize results of research related to tuberculosis and the role of nurses in the care of this patient. This is a descriptive study, with a qualitative approach such as bibliographic review. It was observed in the study the importance of nursing that plays a crucial role in tuberculosis control programs, being the protagonist in the prevention and control of tuberculosis, performing Or planning interventions in a comprehensive way.

A preliminary exvivo diffusion tensor imaging study of distinct aortic morphologies.

Changes in the microstructure of the aortic wall precede the progression of various aortic pathologies, including aneurysms and dissection. Current clinical decisions with regards to surgical planning and/or radiological intervention are guided by geometric features, such as aortic diameter, since clinical imaging lacks tissue microstructural information. The aim of this proof-of-concept work is to investigate a non-invasive imaging method, diffusion tensor imaging (DTI), in exvivo aortic tissue to gain insights into the microstructure. This study examines healthy, aneurysm and a type B chronic dissection aortae, via DTI. DTI-derived metrics, such as the fractional anisotropy, mean diffusivity, helical angle and tractography, were examined in each morphology. The results from this work highlighted distinct differences in fractional anisotropy (healthy, 0.24 ± 0.008; aneurysmal, 0.19 ± 0.002; dissected, 0.13 ± 0.006) and a larger variation in the helical angle in the dissected aorta compared to healthy (39.28 ± 11.93° vs. 26.12 ± 4.60°, respectively). These differences were validated by histological characterisation. This study demonstrates the sensitivity of DTI to pathological changes in aortic tissue, highlighting the potential of this methodology to provide improved clinical insight.

Formative Research for Adapting the Cholera-Hospital-Based-Intervention-for-7-Days (CHoBI7) Water Treatment and Hygiene Mobile Health Program for Scalable Delivery in Rural Bangladesh

The Cholera-Hospital-based-Intervention-for-7-Days (CHoBI7) mobile health (mHealth) program is a targeted water treatment and hygiene (WASH) program for the household members of diarrhea patients, initiated in the healthcare facility with a single in-person visit and reinforced through weekly voice and text messages for 3 months. A recent randomized controlled trial of the CHoBI7 mHealth program in urban Dhaka, Bangladesh, found that this intervention significantly increased WASH behaviors and reduced diarrhea prevalence. The objective of this present study was to conduct formative research using an implementation science framework to adapt the CHoBI7 mHealth program for scalable implementation in rural Bangladesh, and to promote construction of self-made handwashing stations (CHoBI7 Scale-up program). We conducted a 3-month multi-phase pilot with 275 recipients and 25 semi-structured interviews, 10 intervention planning workshops, and 2 focus group discussions with intervention recipients and program implementers. High appropriateness, acceptability, and adoption of the CHoBI7 Scale-up program was observed, with most recipients constructing self-made handwashing stations (90%) and chlorinating drinking water (63%) and 50% of participants observed handwashing with soap in the final pilot phase. At the recipient level, facilitators included weekly voice and text messages with videos on handwashing station construction, which served as reminders for the promoted water treatment and hand hygiene behaviors. Barriers included perceptions that self-made iron filters commonly used in households also removed microbial contamination from water and therefore chlorine treatment was not needed, and mobile messages not always being shared among household members. At the implementer level, facilitators for program implementation included follow-up phone calls to household members not present at the healthcare facility at the time of intervention delivery, and the promotion of multiple self-made handwashing station designs. Barriers included high patient volume in healthcare facilities, as well as the high iron in groundwater in the area that reduced chlorination effectiveness. These findings provide valuable evidence for adapting the CHoBI7 mHealth program for a rural setting, with a lower-cost, scalable design, and demonstrated the important role of formative research for tailoring WASH programs to new contexts.

Insights and trends review: Use of extended reality (xR) in hand surgery.

Digital transformation through extended reality (xR)-comprising virtual, augmented, mixed, and substitutional reality-has become an integral part of the future of clinical and surgical practice. xR technologies facilitate advanced surgical planning, training, therapies and education, reshaping both personal and institutional healthcare. This paper examines the potential changes that xR has introduced into the field of hand surgery, exploring how xR enhances patient-centric care, increases medical service efficiency and revolutionizes surgical training, planning and therapeutic interventions. Key areas such as surgical assistance, telemedicine, therapies and rehabilitation, medical training and education, and improving patient understanding are highlighted. By synthesizing the current literature, this narrative review articulates the theoretical and practical implications of xR, offering insights into its transformative potential and supporting continuous educational advancement in medical practice.

Risk assessment and management strategies for peri-implantitis in high-risk populations⁠

Peri-implantitis is a multifactorial condition characterized by inflammation and progressive bone loss surrounding dental implants, often leading to implant failure. High-risk populations, including patients with systemic conditions such as diabetes or undergoing cancer treatments, face an elevated susceptibility due to impaired immune responses and altered bone metabolism. Understanding the pathophysiological mechanisms underlying the disease is essential for effective risk assessment and management. Dysbiosis of the microbial biofilm, immune system dysregulation, and systemic factors like oxidative stress and cytokine imbalances are critical contributors to disease progression. These factors necessitate the development of targeted strategies for prevention and intervention. Risk assessment models have evolved to include advanced technologies such as artificial intelligence and decision tree regression to predict peri-implantitis in vulnerable individuals accurately. These tools incorporate systemic, local, and implant-specific parameters to enable personalized treatment planning and early intervention. Innovative management strategies have also emerged, ranging from adjunctive antimicrobial therapies, such as glycine powder air-polishing and localized drug delivery systems, to host modulation therapies and regenerative techniques. The use of advanced biomaterials, such as implants coated with bioactive peptides or antimicrobial nanoparticles, has further improved osseointegration and reduced infection rates. Regenerative approaches, including the application of growth factors like platelet-derived growth factor and bone morphogenetic proteins, have shown significant potential in repairing peri-implant defects and restoring functional stability. Emerging technologies, such as nanotechnology and bioengineered implants, offer new possibilities for real-time health monitoring and sustained therapeutic delivery at implant sites. These advancements, coupled with a deeper understanding of peri-implantitis etiology, provide a framework for optimizing outcomes in high-risk populations, addressing both the local and systemic challenges posed by the disease.

What have we learnt from histology about the efficacy of coronary imaging modalities in assessing plaque composition?

Accurate evaluation of coronary artery pathology is essential for risk stratification and tailoring appropriate treatment. Intravascular imaging was introduced for this purpose 40 years ago enabling for the first time in vivo plaque characterization. Since then, several studies have evaluated the efficacy of the existing intravascular imaging modalities in assessing plaque pathology and composition and their potential in guiding intervention and predicting vulnerable plaques. Today it is known that intravascular imaging is an indispensable tool in percutaneous coronary intervention planning, but the existing modalities have a limited efficacy in predicting lesion vulnerability; a fact that should be attributed to their advantages and limitations in accurately assessing morpho-pathological features that are common in advanced atherosclerotic plaques. This review aims to provide a comprehensive evaluation of the performance of intravascular imaging in characterizing plaque phenotypes using histology as a reference standard; it summarizes the studies comparing the available invasive imaging techniques against histology, discusses the findings and limitations of these studies and highlights the potential of novel intravascular imaging approaches that were introduced for a more complete and comprehensive evaluation of plaque pathobiology.

Crafting Behavior Goal Cocktails: What’s in Yours? Writing Behavioral Goals in Early Childhood

Early childhood education teachers often feel underprepared for addressing behavior challenges in the classroom. This can limit a teacher’s ability to teach academic and social skills and lead to interruptions in their educational experience such as suspensions or expulsions. Effective planning can help teachers create and manage positive learning environments. In this article, we describe how to effectively write behavior intervention plan goals for early childhood settings. Resources are shared to support early childhood behavioral goal creation.

Stress assessment instruments for hospitalized preterm newborns: scoping review

BackgroundThe highly technological environment existing in intensive care units, essential for the survival of the newborn, contributes with a potentially devastating and traumatic effect, especially in preterm newborns and in their future lives, due to the early and frequent exposure to multiple stressors. The preterm newborn must be observed in a systematic and structured way, before, during and after any intervention, aiming at the correct assessment and interpretation of his behaviour and signs of stress, and at the timely planning of interventions that minimize and prevent stress. The objective of this review is to identify and map the instruments for assessing stress in preterm newborns admitted to neonatal units in scientific evidence.MethodsA scoping review was carried out using the methodology presented by The Joanna Briggs Institute (JBI) and the PRISMA ScR model (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extended for Scoping Reviews) for structuring the collected information. The research was carried out in three distinct phases supported by the Medline, CINALH databases through the EBSCO, Scielo and PubMed platform. Two reviewers screened all citations, abstract data and full-text articles, independently.ResultsTen articles were selected, all primary studies. Seven different scales were identified in the studies.DiscussionThis review highlights the limited availability of instruments exclusively designed to assess neonatal stress in neonatology. While most tools, like the Newborn Comfort Behavior Scale and ALPS-Neo, focus on pain and stress together, the NISS and NSS provide valuable insights despite limitations in capturing individualized stress responses. Differentiating stress from pain is crucial for implementing targeted, neuroprotective interventions. Adapting neonatology environments and care practices to minimize stressors is essential for promoting newborns' well-being and long-term development.ConclusionThe findings underscore the critical need for stress-specific assessment tools in NICUs to differentiate between pain and stress. Existing instruments offer valuable insights but have notable limitations. Expanding validated tools and prioritizing individualized, neuroprotective care are essential for improving outcomes. Adapting neonatology practices to reduce stressors and implement family-centered care will support the holistic needs of newborns, fostering their development, physiological stability, and overall well-being.System review registrationOpen Science Framework (https://osf.io/nsu95/).

Implementation of An Advance Care Planning Intervention in Dialysis Clinics.

Sharing Patient's Illness Representations to Increase Trust (SPIRIT) is an evidence-based advance care planning intervention targeting dialysis patients and their surrogate decision-makers. To address SPIRIT's implementation potential, we report on a process evaluation in our recently completed five-state cluster-randomized trial. A descriptive study of implementation within a randomized clinical trial. 231 patient-surrogate dyads and 60 dialysis care providers in the 22 active intervention clinics. Status as a patient/surrogate, care provider, or care provider "champion" who all were randomized to clinics implementing the SPIRIT implementation. OUTCOME(S): (1) Intervention reach (e.g., number of dyads who received SPIRIT relative to each clinic's census); (2) fidelity (e.g., champions' self-evaluation checklists, patient and surrogate surveys); (3) sustainability (patient, surrogate and dialysis care provider acceptability surveys); and (4) context (e.g., clinic characteristics). 191 (82.7%) completed SPIRIT session 1 and 146 (76.4% of 191) completed the optional session 2. Of the 40 champions, 34 completed at least one SPIRIT session 1. Champions reported that all six intervention steps were completed in 98% to 100% of their sessions. The median duration of session 1 and session 2 were 60 minutes and 15 minutes, respectively. The acceptability surveys suggested a high-level of acceptance by patients, surrogates, and providers. Champions reported the main benefits of SPIRIT to be enhanced learning; communication; and improved relationships for patients, surrogates, and providers. The challenges champions reported were scheduling a time that worked for the patient, surrogate, and champion; feeling torn between SPIRIT and other clinical demands; and the emotional burden on the champions themselves. The lack of data on actual continued use of SPIRIT and low provider participation in acceptability survey. This study suggests that SPIRIT was delivered with high fidelity and was experienced positively by stakeholders. However, challenges such as staffing and emotional burden required clinic-level support and warrant future studies testing implementation strategies to address these barriers.

Criticality disaster risk assessment for urban rail transport in Indonesia

The increasing frequency of extreme weather events due to climate change poses significant risks to urban rail systems, especially in disaster-prone regions like Indonesia. Urban railways, with limited rerouting options, are highly vulnerable to natural disasters such as floods, landslides, and earthquakes. These disruptions can cause cascading economic impacts, including infrastructure damage, productivity loss, and prolonged travel times. This study develops a methodological framework to assess disaster risk and climate vulnerability in urban rail systems, with Bandung, Indonesia, as the case study. The framework integrates Climate Vulnerability and Risk Assessment (CVRA) with the Movement and Place (M&P) framework, leveraging Geographic Information System (GIS) technology to identify and prioritize high-risk areas. CVRA evaluates hazards, exposure, and vulnerabilities, while M&P assesses the functional significance of transport nodes based on movement patterns and land use density. The combined analysis produces a risk matrix, enabling targeted mitigation strategies that integrate engineering solutions, urban planning, and policy interventions. Findings highlight critical vulnerabilities in Bandung’s proposed LRT system, particularly at stations susceptible to earthquakes and landslides. Recommended mitigation measures include resilient infrastructure designs, strategic planning for high-risk zones, and stakeholder engagement for prioritization. This framework offers practical guidance for policymakers to enhance urban rail resilience, reduce climate-related risks, and ensure sustainable urban mobility. It serves as a scalable model for other cities in Indonesia and globally, supporting adaptive and sustainable transport systems.

Examining Spiritual Well-Being as a Protective Factor Against Suicidality in Black Women Dealing with Everyday Discrimination

Research has shown that experiences of systemic oppression, racism, and discrimination are associated with increased psychological distress among Black women and that this might present as thoughts of suicide and suicidal behavior. The current study aims to contribute to the growing literature on suicidality among Black women by examining spiritual well-being as a protective factor that moderates the relationship between everyday discrimination and suicidality. A moderation analysis indicated a significant moderation effect of spiritual well-being on the relationship between everyday discrimination and suicidality in Black women, indicating that at high levels of spiritual well-being, the relationship between everyday discrimination and suicidality becomes weak. The current study aims to provide clinical implications relevant to culturally specific intervention plans for suicide risk among clients who are Black women.

Computed Tomography Angiography in the Catheterization Laboratory: A Guide Towards Optimizing Coronary Interventions.

Cardiac computed tomography (CT) has become an essential tool in the pre-procedural planning and optimization of coronary interventions. Its non-invasive nature allows for the detailed visualization of coronary anatomy, including plaque burden, vessel morphology, and the presence of stenosis, aiding in precise decision making for revascularization strategies. Clinicians can assess not only the extent of coronary artery disease but also the functional significance of lesions using techniques like fractional flow reserve (FFR-CT). By providing comprehensive insights into coronary structure and hemodynamics, cardiac CT helps guide personalized treatment plans, ensuring the more accurate selection of patients for percutaneous coronary interventions or coronary artery bypass grafting and potentially improving patient outcomes.

The adaptation process of a safety planning intervention to promote connectedness and reduce distress in Diné adolescents and adults during the COVID-19 pandemic

IntroductionIndigenous connectedness is an impetus for health, well-being, self-confidence, cultural preservation, and communal thriving. When this connectedness is disrupted, the beliefs, values, and ways of life that weave Indigenous communities together is threatened. In the Spring of 2020, the COVID-19 virus crept into Tribal Nations across the United States and exacerbated significant health-related and educational inequities. The first case of COVID-19, or Dikos Ntsaaígíí-19 in the Diné (Navajo) language, arrived in the Southwest in March 2020. The virus quickly spread amongst Diné communities and contributed to immediate school closures. These closures created significant disruption to connectedness on the Navajo Nation.MethodsAs part of the Community Based Participatory Research process, our team worked with a Community Advisory Board (CAB) to facilitate a longitudinal cohort study titled “Project SafeSchools” and, most critically, to culturally adapt mental health interventions to be implemented as a part of this study. This paper describes the process our team used to select, adapt, and test Safety Planning and Caring Contacts interventions to reduce elevated rates of depression, anxiety, and suicidal ideation amongst Diné adolescents and adults. CBPR was the primary approach used to engage with Navajo Nation communities and the adaptation process was guided by a scoping study of frameworks for adapting public health evidence-based interventions (EBI) and was guided by the cultural adaptation process. Our team met virtually several times in 2021 and 2022 as the parent launched and as the pilot randomized clinical trial called “+Connection is Medicine” started. When Safety Planning and Caring Contacts messaging was selected, the study team, which consisted primarily of Navajo research personnel led by a Navajo community-based principal investigator (PI) and allied PIs with extensive experience in implementation science, infectious disease prevention, and CBPR, were adapted and presented to CAB members. This CAB also included a youth advisory council who participated in the field testing and further adaptation process.ResultsThe use of the CAB allowed for a collaborative workgroup effort to examine the feasibility and acceptability of using safety planning to help reduce suicide risk factors with Navajo adolescents and adults. Most importantly, this CAB collaborative with researchers to further tailor safety plan intervention materials to align with Navajo values related to connectedness to relatives, community, mental health resources, and the land. In addition, the caring contacts messaging was aligned with safety plans to provide culturally sensitive messages that would be shared with randomized participants.DiscussionMental health stigma is highly common in reservation-based communities. In Indigenous communities, mental illness has association with not living well or not living culturally aligned further complicates the likelihood of at-risk community members contacting resources available in their communities. By using an Indigenous approach that restores connectedness, and reminds participants of their belonging, +CiM researchers were able to develop enhanced versions of safety plans to use in their pilot randomized controlled trial.