Under-resourced Communities Research Articles

264 Building Empowerment through FITness (BeFIT)

OBJECTIVES/GOALS: Improving physical activity of African American women experiencing disproportionate health risks from sedentarism, educational and socio-environmental barriers. BeFit: Building Empowerment through Fitness is based on “What I Learned At Home” project, run by Women Under Construction Network, for residents of the Birmingham Housing Authority. METHODS/STUDY POPULATION: A qualitative study design to understand unique cultural context and challenges faced by African American women residing in the Birmingham Housing Authority, regarding physical activity engagement, including sedentarism. A needs assessment approach will help determine barriers, support systems, and social networks. Semi-structured, pre, mid, and post program focus groups will identify challenges and opportunities for health, such as diet and exercise, and will be analyzed by hand with a thematic analysis. The project framework uses exercise and home repair tools with a life-building/life repair curriculum to influence health, self-efficacy, and program engagement. The Study enrollment will include 50 women over two cohorts in a 12-week project. RESULTS/ANTICIPATED RESULTS: This research addresses the urgent health needs of African American women in low-income communities. These women face heightened health risks due to sedentary lifestyles, educational gaps, and socio-environmental barriers. This project targets the pronounced prevalence of allostatic burden in this population by applying a culturally sensitive, bottom-up approach. Our goal of incorporating healthy lifestyles to improve health in at-risk women and their families requires multiple projects. This project is a necessary first step in engaging with a community to identify local environmental circumstances and barriers to increasing the relevance of physical activity within the home. These barriers can then be addressed by adapting an exercise promotion program to the needs of this community. DISCUSSION/SIGNIFICANCE: Black women in under-resourced communities are more likely to be sedentary and have poor health. Exercise programs can be a powerful tool to address disparities and help prioritize health. The circumstances of women in public housing in Birmingham, AL, need community partners to adapt exercise engagement programs to meet environmental challenges.

The Social Determinants of Health and Athletic Trainer Availability in Indiana Secondary Schools.

The social determinants of health (SDOH) are circumstances under which individuals are born, work, and live that influence health outcomes. Previous researchers have examined 1 determinant of economic stability and found disparities in socioeconomic status and athletic trainer (AT) availability. To examine the SDOH characteristics of Indiana secondary schools and AT availability. Cross-sectional study. Database secondary analysis. A total of 426 secondary schools. All data were collected from publicly available databases. The independent variable was AT availability, and schools were classified as having a full-time AT, a part-time AT only, or no AT. The SDOH variables were gathered for each school (at the school and county levels). Data were summarized using measures of central tendencies, 1-way analysis of variance, and Kruskal-Wallis tests. School enrollment was larger in schools with greater AT availability (P< .001). The proportion of non-White students was greater in schools with more AT availability (P= .002). Greater AT availability was present in counties with higher graduation rates (P= .03). Post hoc comparisons revealed differences in graduation rates between schools with a part-time AT and those with no AT (P= .04). Schools with less AT availability were located in counties with a slightly higher percentage of the population uninsured (P= .02). Schools with greater AT availability were located in counties with a higher ratio of population to primary care physicians (P= .03). Schools with less AT availability were located in counties with a higher population experiencing severe housing problems (P= .02). No differences were found in AT availability based on the 3 social and community context variables (P> .05). Differences were noted in AT availability and SDOH characteristics at the secondary school level. We observed less AT availability where high school graduation rates and the population of primary care providers were lower. Strategies should be implemented to improve access to athletic health care in underresourced communities.

239 Promoting Health Equity in South Los Angeles: A Place-Based Initiative in the Nickerson Gardens Housing Development

OBJECTIVES/GOALS: Partnering with the Housing Authority of Los Angeles, we launched a place-based initiative in the Nickerson Gardens housing development in South Los Angeles, where we apply our community engagement approach of listening and learning, and trust and relationship building, to deliver public health interventions in a discrete community. METHODS/STUDY POPULATION: Nickerson Gardens is the largest housing development in Los Angeles, with 1,066 units and over 3,000 residents. 58% and 40% of the residents are Hispanic and Black/African American respectively with an average yearly income of less than $30,000. To build trust and establish relationships, our team began attending community events, holding weekly educational workshops, and participating in the summer program for youth. We also held listening sessions in English and Spanish that asked aboutthe overall health of the Nickerson Gardens community, environment and public space, access and barriers to care, needed healthcare services, and the lived experience within Nickerson Gardens. RESULTS/ANTICIPATED RESULTS: To date, we have held eight 90-minute listening sessions in English and Spanish with 59 participants. The sessions provided insight into theneeded health and educational resources and services, the organizational structure of the housing development and how that impacts access to information and services, as well as the nuanced and area-specific transportation issues and the connection to safety concerns. These findings will inform the next phase of this initiative which includes convening a Coordinating Council composed of service providers and Nickerson Gardens residents. This council will oversee the coordination and implementation of needed services, help maintain accountability of the providers, and offer residents the opportunity to take ownership of the process. DISCUSSION/SIGNIFICANCE: Academic-community partnerships are an effective strategy to deliver public health interventions and promote health equity in under-resourced communities. We tested and measured impact in a distinct community to reinforce a widely-applicable place-based model.

National Benchmarks to Understand How Doctor of Physical Therapy Learners From Minoritized Race and Ethnicity Groups Perceive Their Physical Therapist Education Program.

The demographic homogeneity of the physical therapist workforce and its educational pathway may undermine the profession's potential to improve the health of society. Building academic environments that support the development of all learners is fundamental to building a workforce to meet societal health care needs. The Benchmarking in Physical Therapy Education study uses the Physical Therapy Graduation Questionnaire to comprehensively assess learner perceptions of the physical therapist academic environment. The present report examined whether racial and ethnic minoritized (REM) physical therapist learners perceive their doctor of physical therapy education differently from their non-REM peers. Five thousand and eighty graduating doctor of physical therapy learners in 89 institutions provided demographic data and perceptions of a range of learning environment domains. Analyses included REM versus non-REM comparisons as well as comparisons among individual race and ethnicity groups. Compared with their non-minoritized peers, REM respondents expressed less satisfaction with their education and lower confidence in their preparedness for entry-level practice. REM respondents observed more faculty professionalism disconnects and demonstrated less agreement that their program had fostered their overall psychological well-being. REM respondents experienced higher rates of mistreatment than their peers and reported higher rates of exhaustion and disengagement, the 2 axes of academic burnout. Black/African American and Hispanic/Latino/a/x (Hispanic, Latino, Latina, and/or Latinx) respondents incurred significantly more educational debt than Asian and White respondents. REM respondents reported greater empathy and greater interest in working in underserved communities. REM respondents perceived the physical therapist learning environment more negatively than their non-minoritized peers but expressed strong interest in serving people from underserved communities. These national benchmarks offer academic institutions the opportunity to self-assess their own environment and to work to improve the quality of the educational experience for all learners. In a nationwide benchmarking study, learners from minoritized race and ethnicity backgrounds reported more negative experiences and outcomes during physical therapist education than their non-minoritized peers. These same learners demonstrated high empathy and interest in serving people from underserved (under-resourced) communities. Learning environments that permit all individuals to thrive may be an essential avenue to improve the health of a rapidly diversifying society.

The longitudinal association of adverse events and working memory among preschoolers: A random-intercept cross-lag analysis.

Past research examining the relation between adversity and working memory (WM) has found mixed results and has been limited by methodological issues (e.g., cross-sectional studies, limited measurement of adversity). The present study examined how adverse life events may impact WM among preschoolers who live in financially underresourced families and communities longitudinally over the course of 1 year. The sample included 325 children (aged 3-5 at baseline), recruited because of their increased risk of exposure to high levels of adversity, and their primary caregivers. Children completed WM tasks and caregivers reported on their child's exposure to adverse events in the past 6 months across three time points, each time point occurring 6 months apart. Associations between adverse life events and WM over time were explored using a random-intercept cross-lagged panel model. No relations between preschoolers' adverse event exposure and WM (B = 0.05-0.75, p = .056-.764) were found across the three time points. Results indicated that at the individual level, when controlling for stable covariates, frequency of adverse life event exposure and WM abilities were unrelated to subsequent frequency of adverse event exposure and WM abilities. Findings suggest that WM may continue to develop typically, in the preschool years, despite exposure to adverse life events. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Abstract 17: Associations Between Digital Health App Engagement and Physical Activity Among African American Women With Cardiovascular-Kidney-Metabolic Syndrome: Data From the Step It Up Digital Health-Enabled Physical Activity Intervention

Background: Physical activity (PA) improves cardiovascular-kidney-metabolic health (CKMH); however, few digital health tools to increase PA are tailored for populations disproportionately impacted by adverse social determinants, such as African American (AA) women. Less is known about the effects of engagement with digital health applications (apps) on PA among AA women from under-resourced communities. The objective was to examine associations between app engagement and PA over six months in the Step It Up (SIU) digital health PA intervention. Methods: We enrolled women with ≥Stage 1 CKM syndrome (overweight/obesity) from resource-limited Washington, DC areas into SIU. Before the study, we created the SIU app with community-engaged approaches. Participants used the SIU app and a Fitbit Charge 2 PA monitor for the study. After collecting baseline PA data for two weeks, the app provides interactive PA educational modules, motivational and place-tailored messages about PA, and CKMH self-monitoring tools for six months. We examined associations between overall app and specific feature engagement (i.e. ecological momentary stress assessments (EMA) completed when opening the app, goal setting, modules) with PA (in steps/day) using linear mixed modeling. Results: Participants (N=57) had mean age=60±14 years and BMI=37±8 kg/m 2 . Overall app engagement was positively associated with PA, with each unit increase in engagement associated with 148 more steps/day (p&lt;0.001, Table). Of the app features, engagement with the app EMA was significantly associated with higher PA (p&lt;0.001). Engagement with app goal-setting tools and modules were less significantly associated with higher PA (p=.06 and p=.07 respectively). Conclusions: Engagement with community-tailored, digital health tools like the SIU app can increase PA for AA women with CKM syndrome from under-resourced communities. Future studies should identify methods for increasing engagement in digital health interventions to improve PA and CKMH among AA women.

Abstract P145: Randomized Trial of an Integrated Care Intervention Among Latino Adults: Sustained Effects on Diabetes Management

Purpose: Adequate diabetes management is challenging to sustain. In healthcare practices serving under-resourced communities, the development of cost-efficient interventions with a sustainable impact are crucial. We examined the 12-month maintenance effects of a previously successful integrated model of diabetes care at improving glycemic management and psychological well-being among Latino adults with type 2 diabetes (T2D). Methods: A randomized controlled trial (2015-2019) compared an Integrated Care Intervention (ICI) with Usual Care (UC) among 456 adults with T2D. The ICI included integrated medical and behavioral care and health education over 6 months. Assessments were completed at baseline, 3-, 6-, 9-, and 12-months. Results: Most participants were female (63.7%), with a mean age of 55.7 years. In multi-level models, significant group x time (quadratic) interaction effects were found for HbA1c ( ß = .10, 95% CI .02,.17, p &lt; .01) and anxiety ( ß = .20, 95% CI .05,.35, p &lt; .009), but not depression symptoms ( ß = .15, 95% CI -.01,.31, p &lt; .07). Analyses of instantaneous rate of change in the ICI group showed significant decreases at 3- and 6-months for HbAc1 ( ß = -.31 at 3-months; ß = -.12 at 6-months) and anxiety symptoms ( ß = -.92 at 3-months; ß = -.46 at 6-months), and no significant changes at 9- or 12-months, suggesting that initial improvements were largely maintained. The UC group showed a small decrease in anxiety symptoms at 6 months ( ß = -.17), but no other significant changes (all ps &gt; .05). (See Figure 1). Conclusions: This culturally tailored integrated care model that included both medical and behavioral care and health education programs, shows potential in producing and sustaining positive effects on clinical and psychological outcomes above standard care. Findings have implications for practice and policies that facilitate implementing these models in healthcare organizations.

Promoting physical activity and youth development in schools: the case for near-peer coaches.

Sports-based youth development (SBYD) programs provide an inclusive, supportive environment for promoting physical activity as well as nurturing the development of life skills which, in combination, promote physical, mental, and emotional health in youth. The Up2Us Sports SBYD program was implemented in six schools in New Orleans, Louisiana in 2020-2022, where near-peer coaches from the community were placed in schools and present throughout the school day. The intervention period straddled the COVID-19 pandemic as well as extreme weather events, modifying program delivery. An exploratory case study was conducted to understand participant experience amid program disruptions and modifications, as well as their perceptions of program impact on physical activity and health. Interviews with coaches (n = 7), focus groups with youth (n = 14) and program observation data were triangulated to provide a description of the case. The major theme that emerged from the case study was the centrality of the near-peer mentorship relationships between coaches and youth. Participants believed near-peer relationships facilitated life skill development and increased opportunity for physical activity in schools, but pressures on coaches' time and external challenges in the community were limiting factors to the extent of program impact. This community case study demonstrates the potential role for near-peer mentors in influencing the health and wellbeing of youth from under-resourced communities and highlights the opportunity for school-based SBYD programming to provide youth with a consistent source of both relational and physical activity support.

The relationship between childhood atopic dermatitis and asthma in an under resourced community.

Background: Atopic dermatitis (AD) is an inflammatory skin disease caused by allergen exposures and estimated to affect ∼20% of children. Children in urban areas have a higher prevalence of AD compared with those living outside of urban areas. AD is believed to lead to asthma development as part of the "atopic march." Objective: Our objective was to determine the sequential and chronological relationships between AD and asthma for children in an under-resourced community. Methods: The progression from AD to asthma in the under-resourced, urban community of Sun Valley, Colorado, was examined by assessing Medicaid data for the years 2016 to 2019 for a diagnosis of AD or asthma in children 6 and 7 years old. Results: Pearson correlations between AD and asthma diagnoses were significant only with respect to AD at age 6 years compared with asthma 1 year later, at age 7 years. Conclusion: By studying a susceptible community with a consistent but mixed genetic background, we found sequential and chronological links between AD and asthma.

South African Rural University Students’ Experiences of Open Distance E-Learning Support

South Africa, like many developing countries, has rural areas which suffer from a scarcity of resources and tools required to enable open-distance e-learning. Universal approaches often sideline these communities and the like. The aim of this empirical study was to look at the experiences of rural online students with a lens of openness (widening access) to comprehend their experiences of online support in the Open Distance e-Learning support context. This study followed a descriptive and qualitative case study, which employed individual interviews. The study involved (15) rural participants from University of South Africa. Findings revealed that there were many challenges associated with online learning for rural students. However, the use of cell phones by participants to access online materials and connect to online classes helped widen access to this group of students faced with scarcity of resources and infrastructure. Participants preferred to use cell phones because cell phones easily connect to the internet when compared to computers because cell phones require less bandwidth connection. Additionally, cell phones build a sense of community amongst the participants through the social media platform. Accordingly, the students were enthusiastic and were motivated about working online in the Open Distance e-Learning (ODeL) environment. Therefore, cell phones have a potential to widen access for developing under-resourced communities. Hence, the study emphasises the importance of tailored online support programmes for diverse group of students for ODeL to be considered equivalent to traditional learning. Universities must not presume the culture of use and access for students without background considerations.

Evaluating Social Determinants of Health Related to Cancer Survivorship and Quality of Care.

Social determinants of health posit that negative outcomes are influenced by individuals living in underserved and underresourced neighborhoods. This study examines a cancer diagnosis, race/ethnicity, age, geographic location (residence), education, and social economic status factors at disease onset and treatment. A multivariable PO regression analysis was run for quality of care at testing or diagnosis, and quality of care at treatment and the quality of received care compared with another person. Participants are representative of the Southern Community Cohort Study (SCCS) of adults diagnosed with breast (n = 263), prostate (n = 195), lung (n = 46), colorectal (n = 105), or other cancers (n = 526). This study includes cancer survivors who completed the SCCS Baseline and Cancer Navigation Surveys in urban (73.13%) and rural (26.87%) areas. White participants reported a higher quality of received care for testing or diagnosis and care for treatment compared with Black participants. Participants with high school or equivalent education (odds ratio, 1.662; 95% confidence interval, 1.172-2.356; P = .0044) or some college or junior college education (odds ratio, 1.970; 95% confidence interval, 1.348-2.879; P = .0005) were more likely to report a better level of quality of received care for treatment. The SCCS represents individuals who are historically underrepresented in cancer research. The results of this study will have broad implications across diverse communities to reduce disparities and inform models of care. Nurses are positioned to evaluate the quality of population health and design and lead interventions that will benefit underserved and underresourced communities.

Mobilizing faith-based COVID-19 health ambassadors to address COVID-19 health disparities among African American older adults in under-resourced communities: A hybrid, community-based participatory intervention.

The COVID-19 pandemic disproportionately affected older adults, particularly those with pre-existing chronic health conditions. To address the health disparity and challenges faced by under-resourced African American older adults in South Los Angeles during this period, we implemented a hybrid (virtual/in-person), pre-post, community-based participatory intervention research project utilizing a faith-based lay health advisor model (COVID-19 Health Ambassador Program (CHAP)). We recruited COVID-19 Health Ambassadors (CHAs) and African American older adults (participants) from faith-based organizations who partook in CHA-led meetings and follow-ups that educated and supported the participants. This paper seeks to evaluate this intervention's implementation using the Consolidated Framework for Implementation Research (CFIR) as a reporting tool with an emphasis on fidelity, challenges, and adaptations based on data collected via stakeholder interviews and surveys. CHAP was delivered to 152 participants by 19 CHAs from 17 faith-based organizations. CHAs assisted with chronic disease management, resolved medication-related challenges, encouraged COVID-19 vaccination, reduced psychological stress and addressed healthcare avoidance behaviors such as COVID-19 vaccine hesitancy among the participants. Challenges encountered include ensuring participant engagement and retention in the virtual format and addressing technological barriers for CHAs and participants. Adaptations made to better suit the needs of participants included providing communication tools and additional training to CHAs to improve their proficiency in using virtual platforms in addition to adapting scientific/educational materials to suit our participants' diverse cultural and linguistic needs. The community-centered hybrid approach in addition to our partnership with faith-based organizations and their respective COVID-19 health ambassadors proved to be essential in assisting underserved African American older adults manage chronic health conditions and address community-wide health disparities during the COVID-19 pandemic. Adaptability, cultural sensitivity, and teamwork are key to implementing health interventions especially in underserved populations.

Examining the referral of patients with elevated blood pressure to health resources in an under-resourced community in South Africa

BackgroundLow-and-middle income countries face a disproportionate burden of non-communicable diseases (NCDs) that threaten to overwhelm under-resourced health systems. Community health workers (CHWs) can promote NCD prevention, reach patients, and connect them to local community health resources; however, little has been done to examine how referrals to these resources are utilized by community members. The purpose of this study is to examine the use of referrals to community-based health resources and investigate the factors influencing patient utilization of referrals connecting them to appropriate health resources for elevated blood pressure (BP).MethodsCHWs conducted home visits, which included BP screening and brief counseling, with community members in Soweto, South Africa. Participants with elevated (systolic BP: 121–139/ diastolic BP: 81–89 mmHg) or high (≥ 140/90 mmHg) BP were referred to either a local, community-based physical activity (PA) program managed by a non-governmental organization or local health clinics. The number of participants that received and utilized their referrals was tracked. Follow-up interviews were conducted with individuals given a referral who: (1) went to the PA program, (2) did not go to the PA program, (3) went to a clinic, and (4) did not go to a clinic. Interviews were transcribed and analyzed to identify common themes and differences between groups regarding their decisions to utilize the referrals.ResultsCHWs visited 1056 homes, with 1001 community members consenting to the screening; 29.2% (n = 292) of adults were classified as having optimal BP (≤120/80 mmHg), 35.8% (n = 359) had elevated BP, and 35.0% (n = 350) had high BP. One hundred and seventy-three participants accepted a referral to the PA program with 46 (26.6%) enrolling. Five themes emerged from the interviews: (1) prior knowledge and thoughts on BP, (2) psychosocial factors associated with BP control, (3) perception about receiving the referral, (4) contextual factors influencing referral utilization, and (5) perceived benefits of utilizing the referral.ConclusionCHWs can successfully increase community members’ access to health resources by providing appropriate referrals. However, greater attention needs to address community members’ barriers and hesitancy to utilize health resources.

Abstract TP51: Improving Prescriptions of Cardiovascular-Effective Anti-Diabetic Medications in Patients With Stroke and Type 2 Diabetes

Background and Issue: Type 2 diabetes (DM2) and cardiovascular (CV) disease pose significant risks for ischemic stroke, with a heightened impact on marginalized and under-resourced communities. Despite known CV benefits of newer anti-diabetic medications like glucagonlike peptide 1 receptor agonists (GLP-1 RA) and sodium-glucose co-transporter-2 (SGLT2) inhibitors, these medications are under prescribed. To improve utilization, we conducted a quality improvement (QI) project to enhance prescription rates for these medications. The QI initiative focused on improving diabetes education and ensuring appropriate hypoglycemic medications were provided at discharge, with an aim of reducing the incidence of recurrent strokes. Purpose: The goal of this QI initiative was to improve prescription rates of GLP-1 R or SGLT2 inhibitors in eligible patients with stroke. Method: An assessment of current diabetic referral practices and medical therapy management were conducted, and an algorithm aimed at streamlining referrals for diabetic consults for patients with stroke developed. A diabetic educator or advanced practice nurse was consulted for patients with stroke and elevated A1c. Patients were then evaluated for qualification and use of GLP-1 RA or SGLT2 inhibitors, and discharge recommendations provided. A stroke registry was used to conduct a retrospective analysis of cases with stroke and DM2 for discharged prescriptions of GLP-1 R or SGLT2 inhibitors. Pre-implementation data from October 2021 to March 2022 were compared to post-implementation data from October 2022 to March 2023. Results: A review of 273 cases was completed. Prior to the QI implementation, 14.2% (19 of 134) of cases admitted for stroke with a secondary diagnosis of DM2 and elevated A1c were discharged home on a GLP-1 RA or SGLT2 inhibitor compared with 28.8% (40 of 139) of cases post implementation. Conclusion: Implementation of a QI process aimed at increasing the number of written discharge prescriptions for DM2 medications with proven CV benefits demonstrated a substantial increase in the number of written prescriptions for these medications at discharge.

Implementation of a Booster Sexual Health Education Curriculum for Older Adolescents in Rural Communities.

Ongoing education on sexual health and other health promotion topics is critical as young people transition into adulthood. A "booster" round of education may be an effective strategy to reinforce information previously taught and expand to additional topics relevant later in adolescence. In partnership with a Youth Advisory Council, we co-designed READY, Set, Go!, a booster curriculum for older adolescents with modules covering adult preparation skills, sexual identity, relationships, reproductive health, and mental health. From November 2021 to January 2023, we provided the curriculum to 21 cohorts of 12th grade students (N = 433) in rural communities of Fresno County, CA, and conducted an implementation evaluation to assess its feasibility in school settings, acceptability by participants, and changes in short-term outcomes. Health educators completed implementation logs to track program adaptations. Youth completed pretest/posttest surveys to assess changes in outcomes and participant satisfaction. We used descriptive statistics to examine program adaptations and satisfaction. We used multivariable regression models to examine changes in outcomes, adjusted for sociodemographic characteristics. Health educators completed most activities as planned, with adaptations occurring in response to youth needs and scheduling limitations. Sexual health knowledge, confidence in adult preparation skills, awareness of local sexual and mental health services, and willingness to seek health services all increased significantly from pretest to posttest. Youth feedback was strongly positive. We conclude that booster sexual health education is a promising strategy to address critical knowledge gaps and support health promotion, especially in rural and other under-resourced communities.

Software-driven chronic disease management: Algorithm design and implementation in a community-based blood pressure control pilot

Background: Optimal guideline-directed medical therapy is rarely attained in practice, resulting in inadequate control of diseases such as hypertension, with poorer results in under-resourced communities. Technology, including artificial intelligence-driven decision support and software-driven workflow transformation, can potentially improve disease outcomes at a reduced cost, although it must be integrated with a holistic approach. Methods: We describe the design of a software platform that enables rapid iterative remote management of &gt;20 conditions across cardiac-kidney-metabolic disease. The platform distributes work across a care team of providers and care navigators, automates decision-making, ordering, and documentation, supports rapid incorporation of new evidence, and launches pragmatic trials. We describe software used in a 500-person community-based blood pressure control implemented as a single-arm quality improvement program. The primary endpoint was the proportion of patients meeting the Healthcare Effectiveness Data and Information Set quality measure blood pressure goal (&lt;140/90) at 12 weeks. Results: A total of 1609 patients were screened, 945 (59%) were found to have uncontrolled hypertension, and 512 patients consented to join the program. The average age was 61 ± 11 years; 59% were female, and 99% self-identified as Black. Blood pressure distribution was: 10% Stage 1 (SBP 130–139 mmHg or DBP 80–89 mmHg), 69% Stage 2 (SBP 140–179 mmHg or DBP 90–119 mmHg), and 21% Stage 3 (SBP &gt;180 mmHg or DBP &gt;120 mmHg). Two hundred four patients (39%) proceeded to a provider encounter, and 160 of these (78%) completed the program. The Healthcare Effectiveness Data and Information Set blood pressure goal was achieved in &lt;12 weeks of enrollment for 141 participants (69% of those enrolled, 88% of those who completed the program). Conclusion: Software-driven remote blood pressure is feasible, although strategies to improve patient enrollment will be needed to achieve maximum impact. Future work will be required to compare outcomes to usual care and evaluate concurrent management of multiple cardiac-kidney-metabolic conditions.

Ethics and benefits of family participation in global surgery: a review of the One World Surgery experience

Short-term experiences in global health (STEGHs) provide the opportunity to improve individual patient care and build systemic capacity in under-resourced communities. While most STEGHs are conducted by teams of clinical practitioners and/or trainees, there are some organizations in which nonclinical family members of medical/surgical volunteers participate. One World Surgery is an example of an organization that encourages family member participation in its short-term volunteer trips to Honduras. Through careful pretrip orientation, on-site supervision, and consistent educational programs, One World Surgery has developed a program which promotes safe and effective participation of family members. A recent survey of preprofessional volunteers confirmed that participants felt appropriately supervised and well prepared for their STEGH duties; as a testament to their experience, 100% of these volunteers indicated they would like to return for another One World Surgery experience. The purpose of this paper is to highlight the benefits of family member participation in STEGHs and share the experience of one organization in which family member participation has been developed to provide ethical, beneficial, and sustainable care.

The application of quality improvement concepts, strategies, and tools to enhance participation in clinical trials among Latino families.

Underrepresentation of people from racial and ethnic minoritized groups in clinical trials threatens external validity of clinical and translational science, diminishes uptake of innovations into practice, and restricts access to the potential benefits of participation. Despite efforts to increase diversity in clinical trials, children and adults from Latino backgrounds remain underrepresented. Quality improvement concepts, strategies, and tools demonstrate promise in enhancing recruitment and enrollment in clinical trials. To demonstrate this promise, we draw upon our team's experience conducting a randomized clinical trial that tests three behavioral interventions designed to promote equity in language and social-emotional skill acquisition among Latino parent-infant dyads from under-resourced communities. The recruitment activities took place during the COVID-19 pandemic, which intensified the need for responsive strategies and procedures. We used the Model for Improvement to achieve our recruitment goals. Across study stages, we engaged strategies such as (1) intentional team formation, (2) participatory approaches to setting goals, monitoring achievement, selecting change strategies, and (3) small iterative tests that informed additional efforts. These strategies helped our team overcome several barriers. These strategies may help other researchers apply quality improvement tools to increase participation in clinical and translational research among people from minoritized groups.

Perceptions and Experiences of Community Solidarity during COVID-19 in Two Under-Resourced Communities in South Africa

Perceptions and Experiences of Community Solidarity during COVID-19 in Two Under-Resourced Communities in South Africa

Sustainability and Privilege: A Critique of Social Design Practice

In Sustainability and Privilege, Gabriel Arboleda wrestles with the language of social design, sometimes known as social impact design, public interest design or, in my corner of the field, community-engaged design. The disparate language speaks to varied intentions and methodologies of practice among social designers today. Arboleda’s account stands at odds with stories told by the “starchitects” of social design. As indicated by the book’s subtitle, he critiques the role of architects working in (rather than with) underresourced communities and the unpersuasive justifications given for their work, with insufficient recognition of lessons learned. Arboleda ultimately offers a research-based call for a participatory practice that redistributes power in social design processes to better meet local needs. As the field continues to gain prominence, his evaluation of social design practice is useful in centering the well-being of communities.