Virtual Health Research Articles

Resiliency among older adults receiving lung cancer treatment (ROAR-LCT): A novel supportive care intervention for older adults with advanced lung cancer

IntroductionNovel supportive care interventions designed for an aging population with lung cancer are urgently needed. We aimed to determine the feasibility of a novel supportive care physical therapy (PT) plus progressive muscle relaxation (PMR) intervention delivered to older adults with advanced lung cancer in the United States (US). Materials and MethodsThis clinical trial, Resiliency Among Older Adults Receiving Lung Cancer Treatment (ROAR-LCT: NCT04229381), recruited adults aged ≥60 years with unresectable stage III/IV non-small cell (NSCLC) or small cell lung cancer (SCLC) receiving cancer treatment at The James Thoracic Oncology Center (planned enrollment, N = 20). There were no exclusion criteria pertaining to performance status, laboratory values, prior cancer diagnoses, comorbidities, or brain metastases. Participants were evaluated by PT and psychology and given an exercise pedaler, resistance bands, a relaxation voice recording, and instructions at study initiation. Participants were evaluated in-person by PTs and psychologists at the start and end of the 12-session intervention, with the intervening sessions conducted via virtual health. Participants completed self-reported measures of functional status, symptoms, and mood longitudinally with the following instruments: EQ-5D-5L, Patient Health Questionnaire-9, and General Anxiety Disorder-7. PT assessments included the Short Physical Performance Battery (SPPB) and the two-minute walk test. Feasibility was defined as at least 60% of participants completing at least 70% of all intervention sessions. Optional gut microbiome samples and activity monitoring data (ActiGraph®) were also collected. ResultsThe ROAR-LCT study concluded after consenting 22 patients. Among the 22 consented, 18 (81.8%) started the intervention; 11 participants (61.1%) completed at least 70% of all study sessions. All participants with SCLC completed the intervention. Reasons for withdrawal included progression of disease or hospitalization. The majority (88.9%) of patients who started were able to complete at least one virtual health session. Participants' functional status, SPPB, depression, and anxiety scores were stable from pre- to post-intervention. Participants who withdrew had worse baseline scores across domains. Seven microbiome and six ActiGraph® samples were collected. Discussion: This is one of the first PT + PMR supportive care interventions using virtual health among older adults with advanced lung cancer to achieve feasibility in the US.

Genetic Variants in the ABCB1 and ABCG2 Gene Drug Transporters Involved in Gefitinib-Associated Adverse Reaction: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis aimed to verify the association between the genetic variants of adenosine triphosphate (ATP)-binding cassette subfamily B member 1 (ABCB1) and ATP-binding cassette subfamily G member 2 (ABCG2) genes and the presence and severity of gefitinib-associated adverse reactions. We systematically searched PubMed, Virtual Health Library/Bireme, Scopus, Embase, and Web of Science databases for relevant studies published up to February 2024. In total, five studies were included in the review. Additionally, eight genetic variants related to ABCB1 (rs1045642, rs1128503, rs2032582, and rs1025836) and ABCG2 (rs2231142, rs2231137, rs2622604, and 15622C>T) genes were analyzed. Meta-analysis showed a significant association between the ABCB1 gene rs1045642 TT genotype and presence of diarrhea (OR = 5.41, 95% CI: 1.38-21.14, I2 = 0%), the ABCB1 gene rs1128503 TT genotype and CT + TT group and the presence of skin rash (OR = 4.37, 95% CI: 1.51-12.61, I2 = 0% and OR = 6.99, 95%CI: 1.61-30.30, I2= 0%, respectively), and the ABCG2 gene rs2231142 CC genotype and presence of diarrhea (OR = 3.87, 95% CI: 1.53-9.84, I2 = 39%). No ABCB1 or ABCG2 genes were positively associated with the severity of adverse reactions associated with gefitinib. In conclusion, this study showed that ABCB1 and ABCG2 variants are likely to exhibit clinical implications in predicting the presence of adverse reactions to gefitinib.

The Search for Care Delivery Innovation

A survey of the NEJM Catalyst Insights Council finds enthusiasm for technology innovation to improve care delivery, led by artificial intelligence, big data analytics, and virtual health.

Virtual Healthcare Revolution: Understanding Nurse Competencies and Roles.

Digital healthcare, especially virtual health, has changed nurses' jobs and skills. In the evolving healthcare landscape, nurses healthcare landscape is increasingly required to have diverse competencies to navigate the world of virtual health effectively. This study aims to qualitatively explore the role of nurses in virtual health and the competencies required to work in virtual health in Saudi Arabia, with a specific focus on SEHA virtual hospital. An online open survey with nursing experts was employed as the qualitative method approach during the initial phase of an online Delphi study design. Twelve core competencies were identified: digital technology proficiency, professionalism, clinical expertise, leadership, legal and ethical considerations, care coordination, documentation, effective communication, patient assessment and diagnosis, patient safety, patient-centered care, and remote patient monitoring. The research emphasizes the crucial role of nurses in virtual hospitals and clinics, contributing to the expansion of the virtual healthcare environment. It presents a thorough competency framework that can guide the development of training programs and policies, enhancing the effectiveness of virtual healthcare delivery. The study provides a foundational competencies list that can guide the development of comprehensive training programs for nurses in virtual healthcare. Policymakers and educational leaders are encouraged to use these findings to create standardized practices and policies, enhancing the effectiveness and efficiency of virtual healthcare delivery.

Eficácia das atividades de educação alimentar e nutricional em crianças menores de dois anos de idade: uma revisão sistemática

Abstract Objectives: to evaluate the effectiveness of food and nutritional education on children up to the age of two. Methods: the systematic review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses. The research was carried out in 2022 in the Virtual Health Library/Lilacs, Pubmed/Medline and Science Direct databases. The articles were selected independently using the Microsoft Excel® program. Articles that evaluated food and nutritional education applied on children up to the age of two were included. The risk of bias was assessed using the Joanna Briggs Institute tool. Results: the research resulted in 1,523 studies and nine were included in the review. The articles presented a low risk of bias and good methodological quality. Food and nutritional education strategies were developed especially with the children’s parents. Workshops, lectures, and teaching materials were developed. In most of the studies, the activities developed helped to improve children’s health and eating patterns. Conclusion: food and nutritional education activities have therefore been effective in building healthy eating habits at childhood. Prospero registration: CRD42022325608.

The Trend of Research on Design for Healthy Ageing: A Visual Analysis Using VOSviewer and CiteSpace

Background: Based on the research needs of Design for healthy ageing, policy support visualizes and analyzes the output distribution, research hotspots, and cutting-edge trends of Design for healthy ageing related literature. Research Aim: In order to better carry out research in the field of design for healthy ageing segmentation, we use core data-bases to explore the progress of design for healthy ageing area research at home and abroad from a macro perspective. Methods: The method uses the Web of Science core col-lection database and China National Knowledge Infrastructure (CNKI) database as data sources to export the output distribution, research hotspots, and cutting-edge trend visualization graphs of literature. Results: The results were compared and reviewed with the help of visual literature analysis software VOSviewer and Citespace on relevant literature both domestically and internationally. Conclusions: The time course of research progress on ageing design and the development prospects of ageing design research discipline were summarized. Summarize the research progress and cutting-edge trends in the field, per-spective, and content of ageing design discipline. The conclusion is influenced by policies and the environment, and there are certain similarities and differences in domestic and foreign research. In the context of the sudden global epidemic, the exploration of social par-ticipation in design for the elderly is a common research hotspot. The difference lies in that foreign research focuses on Service design for the elderly, focusing on the health ageing framework of WHO, targeting families, basic nursing services, virtual health and design for healthy ageing service technologies.

300 colleges, universities expand student access to MH resources

TimelyCare, a virtual health and well‐being provider in higher education, last week announced that it has expanded access to care for more than two million students at 300 colleges and universities, a news release stated. According to a recent survey by the media company and online publication, Inside Higher Ed, two‐thirds (65%) of college presidents planned to increase their institution's capacity to meet the mental health needs of their students, faculty and staff this year and, so far, they've kept their word. Compared to this time last year, twice as many students now have access to TimelyCare's portfolio of services including mental health counseling, on‐demand emotional support, medical care, psychiatric care, health coaching, basic needs assistance, faculty and staff guidance, peer support and self‐guided wellness tools. “Mental health is the number one reason students drop out of college, and we are proud that 75% of TimelyCare students report improvements in their mental health. Campus leaders value the correlation between student mental health and student success, and together we share their vision to help students be well and thrive in all aspects of their lives,” said Luke Hejl, TimelyCare CEO and co‐founder.

300 colleges, universities expand access to MH resources for millions of students

TimelyCare, a virtual health and well‐being provider in higher education, last month announced that it has expanded access to care for more than two million students at 300 colleges and universities, a news release stated. According to a recent survey by the media company and online publication, Inside Higher Ed, two‐thirds (65%) of college presidents planned to increase their institution's capacity to meet the mental health needs of their students, faculty and staff this year and, so far, they've kept their word. Compared to this time last year, twice as many students now have access to TimelyCare's portfolio of services including mental health counseling, on‐demand emotional support, medical care, psychiatric care, health coaching, basic needs assistance, faculty and staff guidance, peer support and self‐guided wellness tools. “Mental health is the number one reason students drop out of college, and we are proud that 75% of TimelyCare students report improvements in their mental health. Campus leaders value the correlation between student mental health and student success, and together we share their vision to help students be well and thrive in all aspects of their lives,” said Luke Hejl, TimelyCare CEO and co‐founder.

The Digitalization of India's Healthcare System: A Paradigm Shift amidst the COVID-19 Pandemic

Aim: This study examines the paradigm shift in India's healthcare sector due to the COVID-19 epidemic, explicitly focusing on adopting digital healthcare. The study explores the innovative initiatives undertaken by both the government and commercial sectors in virtual health and analyzes the long-term benefits of this transition.
 Methodology: The study utilizes a secondary research approach to investigate the development of India's digital healthcare system. Various sources such as reports, surveys, and official documents are reviewed to gather information on implementing digital health solutions. The study examines intelligent devices, telemedicine websites, and platforms like Arogya Setu that have played a crucial role in the digital healthcare revolution. Government programs such as the National Digital Health Mission (NDHM) and the establishment of e-hospitals are also analyzed to understand their impact. The study emphasizes the significance of data mining, the development of digital health records, and the necessary infrastructure to support digital healthcare.
 Results: The results indicate that the COVID-19 pandemic has accelerated the digitization of India's healthcare sector. Adopting digital health solutions, including telemedicine, wearable technology, and artificial intelligence, has gained significant momentum. Initiatives like the NDHM and the establishment of e-hospitals have contributed to the successful implementation of digital healthcare. The study highlights the benefits of digital healthcare, such as improved accessibility, cost-effectiveness, and accuracy of services. The importance of data mining and the development of digital health records are underscored as critical drivers of this transformation.
 Conclusion: To conclude, the COVID-19 pandemic has served as a driving force for the digital transformation of India's healthcare industry. The adoption of digital health solutions and the initiatives taken by the government lay the foundation for a more accessible and patient-centred healthcare future. The study emphasizes the significant implications of digital innovations in healthcare for healthcare organizations, medical device manufacturers, and remote care providers. While acknowledging that in-person treatment is still necessary and that comprehensive digitalization takes time, the study highlights the transformative potential of digitizing healthcare to improve access to care and enhance delivery methods. This digital revolution can potentially revolutionize the healthcare industry and improve healthcare outcomes.

Study examines shift to virtual BH care pre‐ and post‐COVID

The rapid shift to virtual behavioral health care during the COVID‐19 pandemic did not adversely affect care quality, according to researchers at Kaiser Permanente (KP) Mid‐Atlantic Permanente Research Institute in Rockville, Maryland. Researchers examined shifts within virtual health care‐related practices in behavioral health departments from January 2019 to June 2021 in three regions of an integrated health care system.

Successful Implementation of Workflow-Embedded Clinical Pathways During the COVID 19 Pandemic.

Clinical pathways have been found effective for improving adherence to evidence-based guidelines, thus providing better patient outcomes. As coronavirus disease-2019 (COVID-19) clinical guidance changed rapidly and evolved, a large hospital system in Colorado established clinical pathways within the electronic health record to guide clinical practice and provide the most up-to-date information to frontline providers. On March 12, 2020, a system-wide multidisciplinary committee of specialists in emergency medicine, hospital medicine, surgery, intensive care, infectious disease, pharmacy, care management, virtual health, informatics, and primary care was recruited to develop clinical guidelines for COVID-19 patient care based on the limited available evidence and consensus. These guidelines were organized into novel noninterruptive digitally embedded pathways in the electronic health record (Epic Systems, Verona, Wisconsin) and made available to nurses and providers at all sites of care. Pathway utilization data were analyzed from March 14 to December 31, 2020. Retrospective pathway utilization was stratified by each care setting and compared with Colorado hospitalization rates. This project was designated as a quality improvement initiative. Nine unique pathways were developed, including emergency medicine, ambulatory, inpatient, and surgical care guidelines. Pathway data were analyzed from March 14 to December 31, 2020, and showed that COVID-19 clinical pathways were used 21 099 times. Eighty-one percent of pathway utilization occurred in the emergency department setting, and 92.4% applied embedded testing recommendations. A total of 3474 distinct providers employed these pathways for patient care. Noninterruptive digitally embedded clinical care pathways were broadly utilized during the early part of the COVID-19 pandemic in Colorado and influenced care across many care settings. This clinical guidance was most highly utilized in the emergency department setting. This shows an opportunity to leverage noninterruptive technology at the point of care to guide clinical decision-making and practice.

Analysis of the virtual healthcare model in Latin America: a systematic review of current challenges and barriers.

The virtual care model can be used in all aspects of healthcare, such as prevention, diagnosis, treatment, and follow-up of most medical and surgical conditions. The objective of this study was to identify the current barriers to implementing and consolidating the virtual healthcare model, of "telemedicine", in Latin American countries. A systematic review was conducted through four databases: PubMed, Scopus, Web of Science, and Virtual Health, including articles in Spanish, Portuguese, and English. A combination of Boolean operators was used with the terms "telemedicine", "telehealth", "telecare", "home care services", "remote care" and the name of each Latin American country. Articles published from January 2020 to January 2023 that reported on the barriers and challenges of using the virtual care model were included. Nineteen articles were included. Brazil (n=5) and Argentina (n=4) were the countries where there was the greatest interest to explore barriers to virtual care. The barriers identified were categorized into five main themes: (I) technological and technical issues; (II) absence of a physical examination; (III) patient's negative perceptions; (IV) negative perceptions among healthcare professionals; and (V) structural obstacles and those associated with the healthcare system. The main obstacles reported were connectivity problems, lack of a complete physical examination, issues of privacy, high risk of medical malpractice, and absence of local regulation. The virtual care model is a safe and cost-effective alternative for the delivery of health services, with multiple benefits for patients and their families. The indication for the use of virtual care should be based on a risk model for patient prioritization. Likewise, the analysis of the main barriers and benefits is fundamental to consolidating this model of care and ensuring its expansion in the region.

Qualitative Experiences of Trained Medical Student Coaches Delivering a Community-Outreach Telehealth Coaching Program

<h3>Research Objectives</h3> To describe medical student coaches' experiences leading the Community Outreach teleheAlth program for Covid education and Health promotion (COACH). <h3>Design</h3> Qualitative, descriptive study. <h3>Setting</h3> Online via Zoom video conferencing. <h3>Participants</h3> Trained medical student coaches (n = 19) were recruited from the University of British Columbia via convenience sampling. Seventy-four percent of participants were female and had an average age of 25.6. Most participants (57.9%) were from visible minority populations, and 42.1% administered COACH in suburban/rural areas. <h3>Interventions</h3> COACH included six 30-45-minute one-on-one sessions where student coaches promote positive health behaviours to adults ages 65 or older. <h3>Main Outcome Measures</h3> Participants engaged in a 45-to-60-minute semi-structured interview conducted via one-on-one Zoom video-conferencing calls. Interview questions focused on students' experiences delivering COACH, their understanding of various health-related topics (e.g., chronic care, virtual health, and health promotion), and possible impacts on their beliefs and future practice. Interviews were transcribed verbatim and analyzed thematically. <h3>Results</h3> Three main themes emerged from our thematic analysis, including: (1) exploring opportunities for knowledge and skill acquisition (i.e., learning virtual care, health promotion strategies for chronic care, and client-centered care), (2) developing clinical perspective and acumen (i.e., developing a chronic care perspective, overcoming challenges to health coaching, and developing interest in chronic care practice), and (3) learning to appreciate patient care (i.e., becoming a health motivator and appreciating the opportunity to build rapport). <h3>Conclusions</h3> Findings suggest that COACH supported development of knowledge, skill, and confidence in medical school students in areas of health promotion, virtual care, and chronic disease management. These findings also demonstrate promise for the use of health professional students and telehealth in advancing chronic care health services. <h3>Author(s) Disclosures</h3> We report no real or perceived conflicts of interest.

Pharmacogenetics of taxane-induced neurotoxicity in breast cancer: Systematic review and meta-analysis.

Taxane‐based chemotherapy regimens are used as first‐line treatment for breast cancer. Neurotoxicity, mainly taxane‐induced peripheral neuropathy (TIPN), remains the most important dose‐limiting adverse event. Multiple genes may be associated with TIPN; however, the strength and direction of the association remain unclear. For this reason, we systematically reviewed observational studies of TIPN pharmacogenetic markers in breast cancer treatment. We conducted a systematic search of terms alluding to breast cancer, genetic markers, taxanes, and neurotoxicity in Ovid, ProQuest, PubMed, Scopus, Virtual Health, and Web of Science. We assessed the quality of evidence and bias profile. We extracted relevant variables and effect measures. Whenever possible, we performed random‐effects gene meta‐analyses and examined interstudy heterogeneity with meta‐regression models and subgroup analyses. This study follows the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) and STrengthening the REporting of Genetic Association Studies (STREGA) reporting guidance. A total of 42 studies with 19,431 participants were included. These evaluated 262 single‐nucleotide polymorphisms (SNPs) across 121 genes. We conducted meta‐analyses on 23 genes with 60 SNPs (19 studies and 6246 participants). Thirteen individual SNPs (ABCB1‐rs2032582, ABCB1‐rs3213619, BCL6/‐rs1903216, /CAND1‐rs17781082, CYP1B1‐rs1056836, CYP2C8‐rs10509681, CYP2C8‐rs11572080, EPHA5‐rs7349683, EPHA6‐rs301927, FZD3‐rs7001034, GSTP1‐rs1138272, TUBB2A‐rs9501929, and XKR4‐rs4737264) and the overall SNPs' effect in four genes (CYP3A4, EphA5, GSTP1, and SLCO1B1) were statistically significantly associated with TIPN through meta‐analysis. In conclusion, through systematic review and meta‐analysis, we found that polymorphisms, and particularly 13 SNPs, are associated with TIPN, suggesting that genetics does play a role in interindividual predisposition. Further studies could potentially use these findings to develop individual risk profiles and guide decision making.

Managing a perioperative medicine program.

Perioperative medicine is now a well-recognized albeit still evolving, interdisciplinary subspecialty, which encompasses a wide array of equally invested stakeholders and equally important contributors. The practice of perioperative medicine is fundamentally and optimally a collaborative effort, which aims to provide a comprehensive framework encompassing all aspects of the patient's surgical journey. Moving from a conceptual model of perioperative medicine to an operational perioperative medicine program and clinic requires a methodical management approach. This comprehensive management approach considers a variety of factors, such as defining the mission of a perioperative medicine program, expanding the role of the anesthesiologist and internal medicine hospitalist, recognizing the role of the advanced practice provider, stratifying perioperative management of surgical patients, developing and implementing a program, undertaking a clinical proof-of-concept pilot of a program, scaling up and building out a program, maximizing the electronic health record, leveraging telemedicine and virtual health, and providing adjunctive services.

Characterization of remote second-opinion oncology patients and associated changes in management.

e18563 Background: The utilization of virtual second opinions in oncology has increased considerably in the last decade, driven by the increased complexity of care and desire for expert opinion, improved technologies in telemedicine, and the acceleration of virtual services due to the Covid-19 pandemic. Therefore, it is important to further understand the patient populations that currently use virtual second opinion programs and to measure their effectiveness. Virtual second opinion programs provide a platform for patients to submit their medical history and questions regarding their condition to remote specialists who then render their opinions on diagnosis and management. Currently there is a paucity of research on the types of patient populations that seek second opinions and the outcomes of these rendered opinions. Here we describe the patient characteristics and changes in management associated with utilization of a virtual second opinion service at an academic medical center. Methods: In this IRB-approved retrospective review, we identified 657 cancer patients that utilized a virtual digital health platform to engage in second opinions at Stanford Healthcare. Patient demographics, cancer staging, site of origin, and prior therapeutic and surgical history were collected. Physician opinions rendered were self-classified into “major change in treatment”, “minor change in treatment”, or “no change in treatment.”. Results: The majority of patients who utilized the virtual second-opinion platform had a diagnosis late-stage cancer (with 77.2% at Stage III or IV). Breast cancer was the most common primary tumor site (24.7% of patients) followed by GI (21.9%) and GU malignancies (14.0%). Patients diagnosed with dermatological (4.4%), head and neck (3.3%), and neurological (3.2%) malignancies were least common. Physicians providing the virtual second-opinion were primarily medical oncologists (67.6%), followed by gynecologists (6.8%), urologists (5.2%), radiation oncologists (5.0%), and surgical oncologists (4.4%). Physicians self-reported that in more than half of cases reviewed (53.8%) a minor or major treatment change was recommended. Conclusions: This study showed that patients access second opinion platforms at late stage of cancer disease progression. With treatment changes recommended for more than half of the cases, virtual second opinion programs can potentially have a significant impact on cancer care. Patient satisfaction and clinical outcomes from virtual second opinion programs is an area of on-going research.[Table: see text]

Exploring the Use of Wearable Sensors and Natural Language Processing Technology to Improve Patient-Clinician Communication: Protocol for a Feasibility Study.

BackgroundEffective communication is the bedrock of quality health care, but it continues to be a major problem for patients, family caregivers, health care providers, and organizations. Although progress related to communication skills training for health care providers has been made, clinical practice and research gaps persist, particularly regarding how to best monitor, measure, and evaluate the implementation of communication skills in the actual clinical setting and provide timely feedback about communication effectiveness and quality.ObjectiveOur interdisciplinary team of investigators aims to develop, and pilot test, a novel sensing system and associated natural language processing algorithms (CommSense) that can (1) be used on mobile devices, such as smartwatches; (2) reliably capture patient-clinician interactions in a clinical setting; and (3) process these communications to extract key markers of communication effectiveness and quality. The long-term goal of this research is to use CommSense in a variety of health care contexts to provide real-time feedback to end users to improve communication and patient health outcomes.MethodsThis is a 1-year pilot study. During Phase I (Aim 1), we will identify feasible metrics of communication to extract from conversations using CommSense. To achieve this, clinical investigators will conduct a thorough review of the recent health care communication and palliative care literature to develop an evidence-based “ideal and optimal” list of communication metrics. This list will be discussed collaboratively within the study team and consensus will be reached regarding the included items. In Phase II (Aim 2), we will develop the CommSense software by sharing the “ideal and optimal” list of communication metrics with engineering investigators to gauge technical feasibility. CommSense will build upon prior work using an existing Android smartwatch platform (SWear) and will include sensing modules that can collect (1) physiological metrics via embedded sensors to measure markers of stress (eg, heart rate variability), (2) gesture data via embedded accelerometer and gyroscope sensors, and (3) voice and ultimately textual features via the embedded microphone. In Phase III (Aim 3), we will pilot test the ability of CommSense to accurately extract identified communication metrics using simulated clinical scenarios with nurse and physician participants.ResultsDevelopment of the CommSense platform began in November 2021, with participant recruitment expected to begin in summer 2022. We anticipate that preliminary results will be available in fall 2022.ConclusionsCommSense is poised to make a valuable contribution to communication science, ubiquitous computing technologies, and natural language processing. We are particularly eager to explore the ability of CommSense to support effective virtual and remote health care interactions and reduce disparities related to patient-clinician communication in the context of serious illness.International Registered Report Identifier (IRRID)PRR1-10.2196/37975

Digital health in medicine: Important considerations in evaluating health economic analysis

Digital health in medicine: Important considerations in evaluating health economic analysis

The Impact of COVID-19 on the Delivery of Educational Programs in Native American Communities: Qualitative Study.

BackgroundDespite the availability of culturally responsive sexual health educational programs for American Indian and Alaska Native (AI/AN) youth, barriers to their uptake and utilization persist in tribal communities. These challenges were exacerbated by the COVID-19 pandemic, which required flexible program delivery using both in-person and virtual classrooms.ObjectiveThis exploratory study provides a preliminary understanding of the extent to which pre-existing challenges impact the delivery of culturally responsive sexual health education programs in Native communities and to what extent they were exacerbated by the COVID-19 pandemic. It also highlights the challenges faced by adolescent health advocates when adapting culturally responsive health curricula to online platforms. Finally, this study discloses major socioeconomic, health, and mental challenges experienced by AI/AN youth during the pandemic.MethodsAn exploratory, descriptive, qualitative design approach was adopted to carry out 5 individual and 1 collective in-depth key informant interviews. A total of 8 Native and non-Native sexual health educators served as key informants and shared their personal experiences with the delivery of sexual health education programs for youth during the COVID-19 pandemic. The interviews were conducted virtually from October to November 2020 using Zoom to reach participants dispersed across different regions of the United States. We followed the consolidated criteria for reporting qualitative research (COREQ) as a reference for the study methodology. We also used the Braun and Clarke framework (2006) to conduct a thematic analysis.ResultsExperts’ opinions were structured according to 5 main themes: (1) competing community priorities during COVID-19; (2) moving to web-based programming: skills, training, support; (3) recruiting youth; and (4) challenges for implementation in a household environment; and (5) recommendations to overcome implementation challenges. These themes are complementary, connected, and should be considered holistically for the development, dissemination, and implementation of online sexual health programs for AI/AN youth, specifically during the COVID-19 pandemic. The results raised the following points for discussion: (1) Building partnerships with schools and community organizations facilitates program adaptation and implementation, (2) there is a need to adopt a holistic approach when addressing youth sexual health in AI/AN communities, (3) a systematic and culturally responsive adaptation approach ensures effective virtual program delivery, and (4) community and youth engagement is essential for the success of virtual sexual health programs.ConclusionsFindings can provide recommendations on actions to be taken by sexual health educators and guidelines to follow to ensure cultural sensitivity, effective adaptation, and successful implementation when setting out to advocate for online sexual health programs for AI/AN youth.

Operationalizing and Evaluating Synchronous Virtual Group Health Interventions: Wide-Scale Implementation at a Tertiary Care Academic Hospital.

Group-based health interventions are an important component of health promotion and management. To provide continuity of care throughout the COVID-19 pandemic, our institution undertook a rapid pivot to delivering group-based health interventions via a videoconferencing service which was securely embedded into both the electronic medical record and the patient portal to sustainably address immediate health service delivery needs during the pandemic and beyond. In this paper, we (1) describe the institutionally driven operationalization of a system to provide integrated synchronous video group visits across our hospital and (2) present a proposed strategy to comprehensively evaluate outcomes regarding their implementation, quality, and impact. Lessons for other institutions and the potential future role of synchronous video group visits to enhance how care can be scaled for delivery are discussed.