Risk Management Interventions Research Articles

Co-producing disaster-resilient urban settlements in Ghana: Case of Ahensan, Kumasi

The occurrence of disasters, specifically flooding, has intensified over the past two decades in African cities with devastating impacts on people and properties. In Ghana, cities are beset by weak community and urban planning capacities to contend with climate challenges; exacerbating the vulnerabilities of the urban poor. Given that the urban poor, mostly in informal settlements, are largely excluded from official climate change adaptation and resilience measures, involving them in co-producing disaster risk management interventions to build resilience remains crucial. Premised on six agency interviews and four focus group discussions of residents in Ahensan, Kumasi, the research examined efforts aimed at co-producing integrative disaster risk governance towards building resilience to disaster risks. The findings showed that the dominant disaster in the settlement was flooding. Consequently, there are flood disaster management plans designed to identify and reduce risks. However, these plans do not involve residents in their preparation; rather, they are largely involved in the implementation of the plans. This has resulted in the lack of ownership of these plans by residents and their unwillingness to participate in their implementation. This study concludes that to ensure the ownership of strategies for disaster management towards resilience, residents should be involved at every stage of the process - from plan preparation through to its implementation.

Development and validation of machine learning models to predict frailty risk for elderly.

Early identification and intervention of the frailty of the elderly will help lighten the burden of social medical care and improve the quality of life of the elderly. Therefore, we used machine learning (ML) algorithm to develop models to predict frailty risk in the elderly. A prospective cohort study. We collected data on 6997 elderly people from Chinese Longitudinal Healthy Longevity Study wave 6-7 surveys (2011-2012, 2014). After the baseline survey in 1998 (wave 1), the project conducted follow-up surveys (wave 2-8) in 2000-2018. The osteoporotic fractures index was used to assess frailty. Four ML algorithms (random forest [RF], support vector machine, XGBoost and logistic regression [LR]) were used to develop models to identify the risk factors of frailty and predict the risk of frailty. Different ML models were used for the prediction of frailty risk in the elderly and frailty risk was trained on a cohort of 4385 elderly people with frailty (split into a training cohort [75%] and internal validation cohort [25%]). The best-performing model for each study outcome was tested in an external validation cohort of 6997 elderly people with frailty pooled from the surveys (wave 6-7). Model performance was assessed by receiver operating curve and F2-score. Among the four ML models, the F2-score values were similar (0.91 vs. 0.91 vs. 0.88 vs. 0.90), and the area under the curve (AUC) values of RF model was the highest (0.75), followed by LR model (0.74). In the final two models, the AUC values of RF and LR model were similar (0.77 vs. 0.76) and their accuracy was identical (87.4% vs. 87.4%). Our study developed a preliminary prediction model based on two different ML approaches to help predict frailty risk in the elderly. The presented models from this study can be used to inform healthcare providers to predict the frailty probability among older adults and maybe help guide the development of effective frailty risk management interventions. Detecting frailty at an early stage and implementing timely targeted interventions may help to improve the allocation of health care resources and to reduce frailty-related burden. Identifying risk factors for frailty could be beneficial to provide tailored and personalized care intervention for older adults to more accurately prevent or improve their frail conditions so as to improve their quality of life. The study has adhered to STROBE guidelines. No patient or public contribution.

The Role of Procedure Duration in the Sustainability Assessment of Contaminated Site Management in Italy

The European Union (EU) has placed a strong focus on soil contamination and remediation in its Thematic Strategy for Soil Protection, emphasizing the critical need for comprehensive soil data at the EU level. To effectively support EU soil management strategies, it is necessary to develop soil-related indicators and standardized datasets across all EU member states. However, the lack of standardized methodologies for estimating the time required for contaminated site remediation is a dilemma in Italy and throughout Europe. This study examines statistical data on the time-consuming nature of the contaminated site remediation process in Italy. In fact, early intervention not only simplifies site remediation but also reduces long-term financial obligations such as monitoring costs and potential legal implications. This study categorized data according to remedial procedures, explored different management phases, and revealed different timescales for completing the procedure. The findings show that processes completed after preliminary investigations are often shorter in time than those completed following conceptual model assessments. In contrast, processes that require corrective measures typically take a longer period of time to complete. Notably, remedial interventions tend to have a shorter duration compared to risk management interventions. Furthermore, procedures that address both soil and groundwater contamination generally require more time compared to those that focus only on soil remediation. This study provides valuable insight into the time-consuming aspects of remediation procedures, recommending potential changes to regulatory frameworks to accelerate site remediation activities.

Urban flooding: Coping with Weija Dam spillage by downstream communities in Ghana.

In light of these challenges, the authors advocate a close collaborative working partnerships among stakeholders to provide flood risk management interventions, strategic planned dam spillage that minimises the effect of dam spillage-induced floods on the local communities, early warning systems and planning and enforcement of building regulations.

Psychiatric adverse events associated with GLP-1 receptor agonists: a real-world pharmacovigilance study based on the FDA Adverse Event Reporting System database.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely used due to their profound efficacy in glycemic control and weight management. Within real-world contexts, the manifestation of certain psychiatric adverse events (AEs) has been observed, which is potentially linked to the administration of GLP-1 RAs. The objective of this study was to undertake a comprehensive investigation and characterization of the psychiatric AEs associated with GLP-1 RAs. We retrieved reports of AEs associated with treatment with GLP-1 RAs during the period from the first quarter (Q1) of 2004 to Q1 2023 from the FDA Adverse Event Reporting System (FAERS) database. Descriptive analysis was performed to examine the clinical characteristics and time to onset of the psychiatric AEs caused by GLP-1 RAs. Moreover, disproportionality analyses were performed using the reporting odds ratio (ROR) to identify GLP-1 RA-related psychiatric AEs. A total of 8,240 reports of psychiatric AEs were analyzed out of 181,238 AE reports with treatment with GLP-1 RAs. Among these cases, a higher percentage was represented by women compared to men (65.89% vs. 30.96%). The median age of these patients was 56 years, with an interquartile range (IQR) of 48-67 years, based on data available in 286 case reports. This study showed that the median time to onset of the overall GLP-1 RA-related AEs was 31 days (IQR = 7-145.4 days), which varied among GLP-1 RA regimens. Specifically, exenatide had a significantly longer onset time at 45 days (IQR = 11-213 days), with statistically significant differences from the onset times of the other five GLP-1 RAs (p< 0.0001). Moreover, eight categories of psychiatric AEs, namely, nervousness (ROR = 1.97, 95% CI = 1.85-2.11), stress (ROR = 1.28, 95% CI = 1.19-1.38), eating disorder (ROR = 1.57, 95% CI = 1.40-1.77), fear of injection (ROR = 1.96, 95% CI = 1.60-2.40), sleep disorder due to general medical condition-insomnia type (ROR = 2.01, 95% CI = 1.60-2.52), binge eating (ROR = 2.70, 95% CI = 1.75-4.16), fear of eating (ROR 3.35, 95% CI = 1.65-6.78), and self-induced vomiting (ROR = 3.77, 95% CI = 1.77-8.03), were defined as GLP-1 RA-related psychiatric AEs through disproportionality analysis. Our findings demonstrate a significant association between GLP-1 RAs and the development of specific psychiatric AEs. Despite the observational nature of this pharmacovigilance study and the inherent limitations of the FAERS database, our preliminary findings in this work could provide a better basis for understanding the potential psychiatric AEs that may occur with GLP-1 RA treatment, assisting clinicians to focus on these AEs and provide early intervention for optimal risk management.

Water quality trade-offs for risk management interventions in a green building

Summary of the water sampling locations, water quality parameters monitored, and intervention methods performed.

COMMUNICATING RISK: DEVELOPING A DISASTER RISK COMMUNICATION MODEL FOR SCHOOL-INITIATED DISASTER RISK REDUCTION AND MANAGEMENT INTERVENTIONS

Informed by the constructivist grounded theory, the research set out with the general goal of understanding disaster risk communication as experienced by extension workers from selected Lasallian schools in the Philippines. The research specifically looked at how research participants from these selected schools define and understand the communication process and purpose in three DRRM phases: disaster preparedness and mitigation, response, and rehabilitation and recovery. Findings show that communication processes are distinctive in the phases of disaster and these processes are affected by inflexible communication system, dated engagement framework, and lack of DRRM training and education. The findings led to the development of a proposed disaster risk communication model for school-initiated DRRM interventions.

Public perception on human exposure risk: A case study on endocrine disrupting compounds in the environment

Humans are exposed to environmental risks owing to the broad usage of endocrine disrupting compounds (EDCs). However, the subjective evaluation of risk levels and characteristics, as well as the variation in risk processing, have not been thoroughly examined. The objective was to understand the public's perception of the risk associated with human exposure to environmental EDCs and identify any variations in risk perception. In this pioneering study conducted within the distinctive social and cultural context of Malaysia, a developing nation, a quantitative analysis approach was employed to assess the subjective evaluation of risk levels and characteristics among the public while developing a risk perception model. Data gathered from surveys and questionnaires were analyzed to gather information on the public's perception of environmental and health issues pertaining to pesticides, hormones, plastics, medicines, and cosmetics. The analysis revealed that the majority of the public assessed the level of human exposure to environmental risks based on experiential processing, which was influenced by cognitive and affective variables. Interestingly, a higher proportion of individuals in the community had a low risk perception of environmental EDCs, surpassing the overall risk perception by 19.3%. Furthermore, the public showed significant awareness of environmental and health issues related to pesticides, hormones, and plastics but had a lesser inclination to acknowledge the vulnerability of humans to risks associated with medicines and cosmetics. These findings suggest that the public is likely to be exposed to environmental EDCs based on their current perceived risks, and that sociopsychological factors play a significant role in shaping perceptions and judgments. This understanding can inform the development of targeted risk management strategies and interventions to mitigate the potential harm caused by environmental EDCs.

ENGAGEMENT OF NURSING HOME COMMUNITY EXPERTS TO MODIFY THE DIGNITY INTERVENTION

Abstract Voices of Nursing Home (NH) residents, family caregivers, staff and leaders (community experts) are underrepresented in research development but integral when developing interventions for implementation these complex organizations. This study aimed to explore opinions of NH community experts in the development of a novel person-centered risk management intervention for residents with dementia. Community engagement studios (CES) engaged 62 community experts to gain their perspectives on the DIGNITY (Decision-making in aging and dementia for autonomy) study procedures and instruments. CESs (N=4) were led by an experienced moderator and co-moderator, recorded, and transcribed verbatim. Content analysis was used to summarize responses in a rapid feedback loop. Descriptive statistics of standard measures describe community experts’ ratings of acceptability, appropriateness, and feasibility of DIGNITY intervention. Most community experts identified as female (85%), ranging from 22 - 86 years. Participants were residents with dementia (n=4); family caregivers (n=4); NH administrators (n=16), care manager/ supervisors (n=10), direct-care workers (n=6) licensed healthcare providers (n=6), other NH staff (n=8), ombudsman (n=4) and state surveyors (n=4). Community experts provided suggestions to adapt the study instruments and delivery methods. The study team made changes to all six intervention elements based on expert feedback. Most experts agreed that the DIGNITY intervention was acceptable (M=17.7, SD= 2.08), appropriate (M= 17.24, SD= 2), and feasible (M=16.91, SD= 2.22) to implement in the NH community. Results support practical modifications to the DIGNITY intervention to make it feasible to implement in an upcoming pilot clinical trial.

Low risk management intervention: Limited impact of remedial tillage on net ecosystem carbon balance at a commercial Miscanthus plantation.

Perennial bioenergy crops are a key tool in decarbonizing global energy systems, but to ensure the efficient use of land resources, it is essential that yields and crop longevity are maximized. Remedial shallow surface tillage is being explored in commercial Miscanthus plantations as an approach to reinvigorate older crops and to rectify poor establishment, improving yields. There are posited links, however, between tillage and losses in soil carbon (C) via increased ecosystem C fluxes to the atmosphere. As Miscanthus is utilized as an energy crop, changes in field C fluxes need to be assessed as part of the C balance of the crop. Here, for the first time, we quantify the C impacts of remedial tillage at a mature commercial Miscanthus plantation in Lincolnshire, United Kingdom. Net ecosystem C production based on eddy covariance flux observations and exported yield totalled 12.16 Mg C ha-1 over the 4.6 year period after tillage, showing the site functioned as a net sink for atmospheric carbon dioxide (CO2). There was no indication of negative tillage induced impacts on soil C stocks, with no difference 3 years post tillage in the surface (0-30 cm) or deep (0-70 cm) soil C stocks between the tilled Miscanthus field and an adjacent paired untilled Miscanthus field. Comparison to historic samples showed surface soil C stocks increased by 11.16 ± 3.91 Mg C ha-1 between pre (October 2011) and post tillage sampling (November 2016). Within the period of the study, however, the tillage did not result in the increased yields necessary to "pay back" the tillage induced yield loss. Rather the crop was effectively re-established, with progressive yield increases over the study period, mirroring expectations of newly planted sites. The overall impacts of remedial tillage will depend therefore, on the longer-term impacts on crop longevity and yields.

Managing post-separation violence: mothers’ strategies and the challenges of receiving societal protection

ABSTRACT Given the profound consequences of post-separation violence on the well-being and quality of life of many women and children, protecting victims from further violence is a paramount concern. Understanding the complex challenges faced by women at risk for such violence is crucial for improving strategies for managing this risk and ensuring the safety of these women and children. In Sweden, access to society’s protective interventions often relies on the women actively seeking them. The aim of this study was to analyse the process of protection against post-separation violence as described by women with children in Sweden. Semi-structured interviews were conducted with women who had experienced domestic violence and were assessed with low to moderate risk of revictimization. The interviews explored strategies they employed on their own and the risk management interventions they received. Through thematic analysis, we identified five themes: activating own safety strategies, seeking societal protection, utilizing societal protection, bridging gaps in societal protection, and resigning to live unprotected. Together, they form a process of protection characterized by mothers employing numerous strategies at different phases to safeguard themselves and their children, relying on their own initiative as well as the assistance offered by society. However, despite these efforts, some mothers and children remained unprotected and were obligated to resign to live with post-separation violence. This study underscores the extensive demands placed on women subjected to violence, despite the presence of relatively strong legal rights and a well-developed societal system.

Ankylosing spondylitis and psychiatric disorders in European population: a Mendelian randomization study.

Epidemiologic evidence has demonstrated a correlation between ankylosing spondylitis and psychiatric disorders. However, little is known about the common genetics and causality of this association. This study aimed to investigate the common genetics and causality between ankylosing spondylitis (AS) and psychiatric disorders. A two-sample Mendelian Randomization (MR) analysis was carried out to confirm causal relationships between ankylosing spondylitis and five mental health conditions including major depressive disorder (MDD), anxiety disorder (AXD), schizophrenia (SCZ), bipolar disorder (BIP), and anorexia nervosa (AN). Genetic instrumental variables associated with exposures and outcomes were derived from the largest available summary statistics of genome-wide association studies (GWAS). Bidirectional causal estimation of MR was primarily obtained using the inverse variance weighting (IVW) method. Other MR methods include MR-Egger regression, Weighted Median Estimator (WME), Weighted Mode, Simple Mode, and Mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO). Sensitivity analyses are conducted to estimate the robustness of MR results. The findings suggest that AS may be causally responsible for the risk of developing SCZ (OR = 1.18, 95% confidence interval = (1.06, 1.31), P = 2.58 × 10-3) and AN (OR = 1.32, 95% confidence interval = (1.07, 1.64), P = 9.43 × 10-3). In addition, MDD, AXD, SCZ, AN, and BIP were not inversely causally related to AS (all p > 0.05). Our study provides fresh insights into the relationship between AS and psychiatric disorders (SCZ and AN). Furthermore, it may provide new clues for risk management and preventive interventions for mental disorders in patients with AS.

The importance of accounting for equity in disaster risk models

Societal efforts to understand and mitigate threats posed by hazards are often informed by complex disaster risk models. Despite research demonstrating the disproportionate effects of disasters on vulnerable groups, current risk modeling approaches lack robust methods to account for such equity concerns. Consequently, efforts to develop evidence-based disaster risk management interventions may lack awareness of differential risks in the settings where they are applied. Here, we draw on the relevant literature to develop a typology for characterizing current approaches to incorporating equity into risk modeling. Using this typology, we then evaluated 69 risk assessments conducted by major international development organizations. We found that only ~ 28% of risk models attempt a quantitative evaluation of the differential impacts of disasters and climate change. We then used an equity-sensitive approach to reconstruct a recent risk assessment and show that important elements are missed when equity is excluded in disaster risk modeling.

A participatory ergonomics intervention to re-design work and improve the musculoskeletal health of paramedics: protocol for a cluster randomised controlled trial

BackgroundIn this paper, we present the protocol for a cluster randomised controlled trial to evaluate the effectiveness and implementation of a participative risk management intervention to address work-related musculoskeletal disorders (WMSDs). The aims of the study include to evaluate the implementation process and the impact of the intervention on work related musculoskeletal pain and discomfort and exposure to physical and psychosocial hazards in paramedics over a 12-month period.MethodsThe intervention in this study is to implement A Participative Hazard Identification and Risk Management (APHIRM) toolkit in an ambulance service. Eighteen work groups containing eligible participants (registered paramedics) will be randomised into the intervention or wait-list control arm in one of three rolling recruitment periods. The APHIRM toolkit survey will be offered at baseline and 12 months later, to all current eligible participants in each work group allocated to the trial. The intervention work groups will receive the remainder of the APHIRM toolkit procedures. Identifying data about individual participants will not be collected in the survey, to protect participant privacy and encourage participation. Changes in primary (musculoskeletal pain and discomfort) and secondary (exposure to physical and psychosocial hazards at work) outcomes measured in the survey will be analysed comparing the baseline and follow up response of the cluster. A process evaluation is included to analyse the implementation and associated barriers or facilitators.DiscussionThis study is important in providing a comprehensive approach which focusses on both physical and psychosocial hazards using worker participation, to address WMSDs, a well-known and significant problem for ambulance services. The effectiveness of the intervention in work groups will be rigorously evaluated. If significant positive results are observed, the intervention may be adopted in ambulance services, both nationally and internationally.Trial registrationISRCTN77150219. Registered 21 November 2021.

Risk management actions following genetic testing in the Cancer Health Assessments Reaching Many (CHARM) Study: A prospective cohort study.

Genetic testing can identify cancer risk early, enabling prevention and early detection. We describe use of risk management interventions following genetic testing in the Cancer Health Assessment Reaching Many (CHARM) study. CHARM assessed risk and provided genetic testing to low income, low literacy, and other underserved populations that historically face barriers to accessing cancer genetic services. CHARM was implemented in Kaiser Permanente Northwest (KPNW) and Denver Health (DH) between 2018 and 2020. We identified post-testing screening (mammography, breast MRI, colonoscopy) and surgical (mastectomy, oophorectomy) procedures using electronic health records. We examined utilization in participants who did and did not receive actionable risk management recommendations from study genetic counselors following national guidelines. CHARM participants were followed for an average of 15.4 months (range: 0.4-27.8 months) after results disclosure. Less than 2% (11/680) received actionable risk management recommendations (i.e., could be completed in the initial years following testing) based on their test result. Among those who received actionable recommendations, risk management utilization was moderate (54.5%, 6/11 completed any procedure) and varied by procedure (mammogram: 0/3; MRI: 2/4; colonoscopy: 4/5; mastectomy: 1/5; oophorectomy: 0/3). Cancer screening and surgery procedures were rare in participants without actionable recommendations. Though the number of participants who received actionable risk management recommendations was small, our results suggest that implementing CHARM's risk assessment and testing model increased access to evidence-based genetic services and provided opportunities for patients to engage in recommended preventive care, without encouraging risk management overuse.

“Stigmatization and perceived dangerousness for intrafamilial child sexual abuse of fathers with a history of sexual offenses and paraphilic interests: Results from a survey of legal psychological experts”

BackgroundIntrafamilial child sexual abuse (ICSA) is a puzzling phenomenon that is not well understood by researches. Nevertheless, psychologists are demanded to assess the risk for child maltreatment by family courts regarding male caregivers with a history of sex offenses and/or paraphilic interests. ObjectiveThe aim of this study was to assess legal psychological experts' perspective on risk assessment in family court proceedings regarding ICSA, their opinions regarding the necessity of contact limitations between fathers/stepfathers who might impose a risk for ICSA, and experts' stigmatization of minor-attracted persons. Participants and setting153 psychological experts working in family court proceedings were assessed via an online survey. MethodJahnke's Stigma Inventory was used as well as a questionnaire tapping into different contact limitations, the perception of child maltreatment risk, and parental capacity. Network analysis was conducted to multivariately investigate item intercorrelations. ResultsFathers/stepfathers with a diagnosed pedophilic disorder are being regarded as most dangerous, 71 % of the experts agreed with the necessity of a complete contact ban. Reduced parental capacity and increased risk for child maltreatment was observed with regard to sexual offending history and paraphilias. ConclusionsPsychological experts in family court proceedings hardly discriminate between sexual offending and paraphilic interests which might be associated with stigmatizing attitudes and lack of experience. An increasing cooperation between family psychologists and experts of forensic risk assessment might reduce the risk of stigmatization and may contribute to more adequate risk assessments for ICSA thus aiding to prevent children from sexual victimization or misinformed risk management interventions.

Effect of Electronic Rounding Board on Falls and Self-harm Among Psychiatric Inpatients: Quality Improvement Project.

More than 1 million falls are reported in US hospitals each year. Psychiatric inpatients are at high risk for self-harm behaviors with reported suicide rate of 6.5 per 1000 patients. Patient observation is the primary risk management intervention in preventing adverse patient safety incidents. This project aimed to examine the effectiveness of handheld electronic rounding board (ObservSMART) implementation on falls and self-harm incidents among psychiatric inpatients. A retrospective review of adverse patient safety incidents was conducted to compare the 6-month preimplementation period versus the 6-month postimplementation period with staff training and implementation in July 2019. The monthly fall rates per 1000 patient-days were 3.53 versus 3.80 during the pre- and postimplementation periods, respectively. About one-third of the falls resulted in mild or moderate injuries for both periods. The incidence of self-harm was 3 versus 7 during the pre- and postimplementation periods, with incidence of 1 versus 6, respectively, among adult patients, who are more likely to hide self-harm. Although there were no changes in falls, the implementation of ObservSMART markedly increased the detection of patient self-harm, including self-injury and suicide attempts. It also ensures staff accountability and provides an easy-to-use tool to perform timely, proximity-based patient observations.

Causal Relationship Between Spot Price &amp; Future Derivative Prices – Case of Crude Oil

This research aims to examine the theoretical and empirical connections between current and future crude oil prices using cutting-edge econometric methods. It surveys existing literature and theoretical frameworks, exploring theories like arbitrage, market efficiency, and risk management techniques. The study then conducts a comprehensive empirical investigation using a large dataset, including data from extreme market volatility and other significant events in the financial world. Time series econometric methods like Granger causality tests, Vector Autoregression (VAR), and impulse response functions are used to capture the causal connections between spot and future prices. The analysis uncovers insights on lead-lag dynamics, volatility spillovers, and both short- and long-term causal impacts between current and future crude oil prices. Market fundamentals, geopolitical developments, and speculative behavior are also highlighted as influencing the causal relationships studied. The findings shed light on the link between future and current crude oil prices and provide valuable insights into the factors influencing these prices. This paper examines the relationship between future and spot crude oil prices, offering valuable insights for energy policy, risk management, hedging techniques, investment allocation, and governmental interventions.

Externally validated machine learning algorithm accurately predicts medial tibial stress syndrome in military trainees: a multicohort study

ObjectivesMedial tibial stress syndrome (MTSS) is a common musculoskeletal injury in both sporting and military settings. No reliable treatments exist, and reoccurrence rates are high. Prevention of MTSS is critical...

180 Enhancing Engagement of Nursing Home Staff and Leaders in Intervention Development

OBJECTIVES/GOALS: Recruiting under-resourced, rural nursing home (NH) staff to clinical research has proven especially difficult during COVID-19. The goal for this study was to leverage an existing group of NH providers to seek their opinions on the development of a novel person-centered risk management intervention for residents with dementia. METHODS/STUDY POPULATION: This study used community engagement studios (CES) to connect and engage with community experts (NH staff and leaders) attending, or in close vicinity to, a NH provider conference in Denver, Colorado July 25-30, 2022. Led by an experienced moderator and an assistant moderator using a semi-structured discussion guide, two CES were completed with 14 community experts. Community experts took part in a 90-minute facilitated and recorded discussion to gain their perspectives on the DIGNITY (Decision-making in aging and dementia for autonomy) study procedures and instruments along with recommendations for how to improve the acceptability, feasibility, and likelihood of intervention success. The local IRB determined this study to not be human research. RESULTS/ANTICIPATED RESULTS: Community experts most often identified as white/Caucasian (64%) females (93%) holding jobs in NHs as direct-care nurse/nursing aide (n=5), nurse supervisor/director (n=4), other NH leadership (n=3), nursing aide union organizers (n=2), and state surveyor (n=1). The primary outcomes of the CES were suggestions that could be used to adapt the elements of the study design. Following CESs, transcripts were reviewed and summarized on a rapid feedback table. The study team made changes to five of the six intervention elements based on expert feedback. Most experts (79%) agreed that the DIGNITY intervention was acceptable, appropriate, and feasible to implement in the NH community. DISCUSSION/SIGNIFICANCE: This study highlighted the voices of NH staff and leaders that is often underrepresented in research development and provides critical information for how to adapt a novel intervention for future testing in rural NH communities. Results also support the usefulness of CES as a method to develop practical interventions in NH communities.