Ethnicity & Disease最新文献

{"title":"Key Principles Underlying a Research-Practice Alignment in a Federally Qualified Health Center.","authors":"Antoinette Schoenthaler, Doreen Colella, Franze De La Calle, Gisella Bueno, Jacalyn Nay, Masiel Garcia, George Shahin, Cristina Gago, Isaac Dapkins","doi":"10.18865/ed.DECIPHeR.6","DOIUrl":"10.18865/ed.DECIPHeR.6","url":null,"abstract":"<p><strong>Context: </strong>Minoritized populations such as racial and ethnic minorities and individuals of less privileged socioeconomic status experience a disproportionate burden of poor hypertension (HTN) control in the United States. Multilevel systems interventions have been shown to improve patient-level outcomes in minoritized populations; however, there remains a large translational gap in implementing these approaches into federally qualified health centers (FQHC), which serve those at highest risk of HTN-related morbidity and mortality. The paucity of purposeful collaborations between academic researchers and practice staff throughout the research process remains a significant roadblock to the timely translation of evidence to practice.</p><p><strong>Design: </strong>This commentary describes the key principles and best practices that underlie the development and sustainment of an equitable research-practice alignment, which is supporting the implementation of multilevel systems intervention for improved HTN care in a large FQHC in Brooklyn, New York. The key principles, which are derived from the central tenants of relationship development and maintenance in community-engaged participatory research, patient-centered outcomes research, and organizational alignment theory include (1) cocreation of a shared mental model, (2) bridging multilevel communication, (3) ensuring mutual accountability, and (4) creating a culture of continuous improvement.</p><p><strong>Conclusions: </strong>Together, the principles guide how the research and practice teams work together to achieve a shared goal of improving the health and well-being of minoritized patients through the provision of high quality, community-oriented HTN care. Best practices to sustain our alignment require an ongoing and deliberate investment in honest and transparent communication by all members.</p>","PeriodicalId":50495,"journal":{"name":"Ethnicity & Disease","volume":"DECIPHeR Spec","pages":"6-11"},"PeriodicalIF":3.4,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-Rated Health and Medically Diagnosed Chronic Disease Association among Adults in Puerto Rico.","authors":"Cristina Gago, H June O'Neill, Martha Tamez, Andrea López-Cepero, José F Rodríguez-Orengo, Josiemer Mattei","doi":"10.18865/ed.33.4.140","DOIUrl":"10.18865/ed.33.4.140","url":null,"abstract":"<p><strong>Introduction: </strong>Latinos report lower self-rated health (SRH) than non-Hispanic White persons. However, the association between SRH and medically diagnosed chronic diseases (MDCDs) remains understudied in Latino populations. This study assessed the relationship between a single-item SRH indicator and MDCD status among predominantly Latino adults in Puerto Rico.</p><p><strong>Methods: </strong>Participants (30-75 years; n=965) of the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT) reported SRH (excellent/very good, good, or fair/poor) and MDCD (ever vs never). We performed multivariate logistic regressions to evaluate the association between SRH and MDCD, which adjusted for key socioeconomic, demographic, and behavioral confounders.</p><p><strong>Results: </strong>Twenty-seven percent of participants reported excellent/very good SRH, 39% good, and 34% fair/poor. Participants with fair/poor SRH (vs excellent/very good) were more likely to report MDCD for painful inflammation (odds ratio [OR]=4.95 [95% CI, 3.27-7.48]), kidney disease (4.64 [2.16-9.97]), sleep disorder (4.47 [2.83-7.05]), migraine headaches (4.07 [2.52-6.58]), overweight/obesity (3.84 [2.51-5.88]), depression (3.61 [2.28-5.74]), hypertension (3.59 [2.43-5.32]), high blood sugar (3.43 [2.00-5.89]), cardiovascular disease (3.13 [2.01-4.87]), anxiety (2.87 [1.85-4.44]), arthritis (2.80 [1.83-4.30]), diabetes (2.46 [1.57-3.83]), respiratory problems (2.45 [1.59-3.79]), stomach problems (2.44 [1.57-3.81]), eye disease (2.42 [1.44-4.06]), gallbladder disease (2.34 [1.35-4.05]), liver disease (2.26 [1.38-3.70]), heartburn (2.25 [1.55-3.26]), hyperlipidemia (2.10 [1.44-3.06]), and thyroid conditions (2.04 [1.30-3.21]).</p><p><strong>Conclusions: </strong>SRH may reflect MDCD burden and serve as a valid screener to efficiently identify Latino individuals in high need of clinical services. This is relevant in Puerto Rico, where chronic disease rates remain high amid limited, disparate access to health care.</p>","PeriodicalId":50495,"journal":{"name":"Ethnicity & Disease","volume":"33 4","pages":"140-149"},"PeriodicalIF":3.4,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11155621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suicide Ideation and the Association of Chronic Disease among American Indians.","authors":"Felicia Schanche Hodge, Rey Paolo Ernesto Roca, Christine Samuel-Nakamura, Wendie Robbins, Umme Shefa Warda","doi":"10.18865/ed.33.4.150","DOIUrl":"10.18865/ed.33.4.150","url":null,"abstract":"<p><strong>Objective: </strong>To explore associations of chronic disease, perceived wellness, adverse experiences, and suicide ideation among American Indians.</p><p><strong>Methods: </strong>Thirteen California health clinic registries formed the random household survey sampling frame (N=459) during the first stage of an intervention trial on wellness. Measures included sociodemographics, wellness status, health conditions, suicide ideation, cultural connectivity (speaking tribal language, participating in cultural practices, and feeling connected to the community), and history of physical, sexual, verbal abuse and neglect in childhood, adolescence, and adulthood. Chi square and Fisher exact tests examined bivariate, unadjusted relationships, while multiple logistic regression analysis examined adjusted associations.</p><p><strong>Results: </strong>Adverse experiences, specifically physical abuse and sexual abuse, were associated with obesity in childhood. Having poor cultural connectivity was significantly associated with (1) low perceptions of wellness; (2) physical abuse in childhood and adolescence; (3) sexual abuse in childhood, adolescence, and adulthood; and (4) verbal abuse and neglect in adulthood. Poor perception of wellness was also correlated with suicide ideation.</p><p><strong>Conclusions: </strong>The relationships between suicide ideation, chronic disease, connectivity, and perception of wellness among American Indians are explored in this article.</p>","PeriodicalId":50495,"journal":{"name":"Ethnicity & Disease","volume":"33 4","pages":"150-155"},"PeriodicalIF":3.4,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11155625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Engaging Predominantly Black Churches in an Intervention to Improve Cardiovascular Health and Reduce Racial Inequities.","authors":"Katherine T Mills, Jodie Laurent, Farah Allouch, Marilyn J Payne, Jeanette Gustat, Hua He, Flor Alvarado, Andrew Anderson, Joshua D Bundy, Jing Chen, Keith C Ferdinand, Jiang He","doi":"10.18865/ed.DECIPHeR.89","DOIUrl":"10.18865/ed.DECIPHeR.89","url":null,"abstract":"<p><p>Cardiovascular disease (CVD) is the leading cause of mortality in the United States and disproportionately impacts Black adults. Effective implementation of interventions to improve cardiovascular health in the Black community is needed to reduce health inequities. The Church-Based Health Intervention to Eliminate Health Inequalities in Cardiovascular Health (CHERISH) study is implementing interventions recommended by the 2019 American College of Cardiology/American Heart Association guideline on the primary prevention of CVD in Black communities to improve cardiovascular health and reduce health disparities. The recently completed 3-year planning phase of CHERISH has focused on engaging with the predominantly Black church community in New Orleans with the goals of informing study protocol development and recruiting churches for study participation. Community engagement approaches include convening a community advisory board (CAB), conducting qualitative and quantitative needs assessments, and hosting and attending church events. These activities have resulted in an engaged CAB that has contributed meaningfully to planning activities and the study protocol. The needs assessment found that while there are substantial barriers to cardiovascular health, such as knowledge, access to healthy foods, and safe spaces for physical activity, people are willing to make lifestyle changes and think that the proposed intervention components are feasible. Community engagement activities have resulted in the recruitment of 50 geographically and denominationally diverse predominantly Black churches willing to participate in the study (exceeding our goal of 42). Overall, a multicomponent approach to extensive community engagement has produced effective church enrollment for study participation and meaningful input on study design and implementation.</p>","PeriodicalId":50495,"journal":{"name":"Ethnicity & Disease","volume":"DECIPHeR Spec","pages":"89-95"},"PeriodicalIF":3.4,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Family Health Equity in Chronic Disease Prevention and Management.","authors":"Katrina R Ellis, Tiffany L Young, Aisha T Langford","doi":"10.18865/ed.33.4.194","DOIUrl":"10.18865/ed.33.4.194","url":null,"abstract":"<p><strong>Introduction/purpose: </strong>Efforts to improve chronic disease outcomes among US adults highlight families, particularly support from families, as a key aspect of disease prevention and management. To date, however, an overwhelming focus on individual-level outcomes and unidirectional support (eg, from a family caregiver to an identified care recipient) belies the existence of co-occurring health concerns and interdependent care. There are increasing calls for more sophisticated and intensive family health interventions that better integrate family-level factors, processes, and outcomes to provide comprehensive family support services in health care and community-based settings.</p><p><strong>Methods: </strong>This commentary provides key considerations for advancing this work while centering family health equity and families themselves in health initiatives.</p><p><strong>Results: </strong>Several critical barriers are identified and discussed. For example, a narrow focus on family and inadequate measures of family-level disease burden make it challenging to understand how the disproportionate burden of chronic disease observed among individuals of lower socioeconomic status and certain racial and ethnic groups compounds and complicates family health experiences. In addition, limited attention to the interaction between individuals, families, and broader sociocultural factors that influence family resources and constraints, such as racism, hamper program design, implementation, and evaluation.</p><p><strong>Conclusion: </strong>To center families in efforts to reduce chronic disease disparities, it is necessary to move beyond superficial attention to the complexity of disease prevention and management within the family context. This commentary serves to enhance understanding of important drivers of family-level chronic disease outcomes, while providing important considerations for advancing research and practice.</p>","PeriodicalId":50495,"journal":{"name":"Ethnicity & Disease","volume":"33 4","pages":"194-199"},"PeriodicalIF":3.4,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11155619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141297162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Process of Engaging Community and Scientific Partners in the Development of the CIRCL-Chicago Study Protocol.","authors":"Justin D Smith, Allison J Carroll, Olutobi A Sanuade, Rebecca Johnson, Emily M Abramsohn, Hiba Abbas, Faraz S Ahmad, Alice Eggleston, Danielle Lazar, Stacy Tessler Lindau, Megan McHugh, Nivedita Mohanty, Sarah Philbin, El A Pinkerton, Linda L Rosul, James L Merle, Yacob G Tedla, Theresa L Walunas, Paris Davis, Abel Kho","doi":"10.18865/ed.DECIPHeR.18","DOIUrl":"10.18865/ed.DECIPHeR.18","url":null,"abstract":"<p><strong>Objectives: </strong>Hypertension affects 1 in 3 adults in the United States and disproportionately affects African Americans. Kaiser Permanente demonstrated that a \"bundle\" of evidence-based interventions significantly increased blood pressure control rates. This paper describes a multiyear process of developing the protocol for a trial of the Kaiser bundle for implementation in under-resourced urban communities experiencing cardiovascular health disparities during the planning phase of this biphasic award (UG3/UH3).</p><p><strong>Methods: </strong>The protocol was developed by a collaboration of faith-based community members, representatives from community health center practice-based research networks, and academic scientists with expertise in health disparities, implementation science, community-engaged research, social care interventions, and health informatics. Scientists from the National Institutes of Health and the other grantees of the Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Risk (DECIPHeR) Alliance also contributed to developing our protocol.</p><p><strong>Results: </strong>The protocol is a hybrid type 3 effectiveness-implementation study using a parallel cluster randomized trial to test the impact of practice facilitation on implementation of the Kaiser bundle in community health centers compared with implementation without facilitation. A central strategy to the Kaiser bundle is to coordinate implementation via faith-based and other community organizations for recruitment and navigation of resources for health-related social risks.</p><p><strong>Conclusions: </strong>The proposed research has the potential to improve identification, diagnosis, and control of blood pressure among under-resourced communities by connecting community entities and healthcare organizations in new ways. Faith-based organizations are a trusted voice in African American communities that could be instrumental for eliminating disparities.</p>","PeriodicalId":50495,"journal":{"name":"Ethnicity & Disease","volume":"DECIPHeR Spec","pages":"18-26"},"PeriodicalIF":3.4,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a Social Determinants of Health Needs Assessment for Colorado Kids (SNACK) Tool for a School-Based Asthma Program: Findings from a Pilot Study.","authors":"Sarah E Brewer, Lisa R DeCamp, Julia Reedy, Rachel Armstrong, Heather H DeKeyser, Monica J Federico, Arthur McFarlane, Gino Figlio, Amy G Huebschmann, Stanley J Szefler, Lisa Cicutto","doi":"10.18865/ed.DECIPHeR.126","DOIUrl":"10.18865/ed.DECIPHeR.126","url":null,"abstract":"<p><strong>Background: </strong>School-based asthma programs effectively address poorly controlled asthma and asthma disparities, especially when coupled with screening for and addressing social determinants of health (SDOH) needs. Existing screening tools are tailored to clinical settings; therefore, we sought to develop a community-based SDOH screening tool.</p><p><strong>Design/methods: </strong>We used a four-phase iterative design process to develop and pilot a community-based screening tool. We used a modified Delphi process to identify screening tool domains, identified validated items for inclusion, and developed an appropriate tool layout for populations with limited health/general literacy. Community advisory boards reviewed and refined a draft tool. Next, we conducted a qualitative pilot test of acceptability to parents and feasibility for staff in a community health center.</p><p><strong>Results: </strong>Six domains are included in our SDOH screening tool: health care access, transportation, food insecurity, public benefits, housing, and utilities. In the pilot test, 41 screenings were completed, and 36 parents (16.7% Spanish speaking) provided feedback. Most families understood the purpose of the screening; felt that the questions were clear, appropriate, and quick to complete; and liked the pictures. The clinic's care coordinator expressed a preference for the pilot tool compared to their existing screening tool and recommended improvements to encourage honest reporting by patients.</p><p><strong>Conclusion: </strong>This community-based screening tool addresses key SDOH needs that impact asthma and is acceptable to families. The next steps are to implement the tool in school-based asthma programs to support improvements in asthma outcomes and disparities by identifying and addressing families' unmet SDOH needs.</p>","PeriodicalId":50495,"journal":{"name":"Ethnicity & Disease","volume":"DECIPHeR Spec","pages":"126-131"},"PeriodicalIF":3.4,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technologic and Nontechnologic Barriers to Implementing Behavioral Health Homes in Community Mental Health Settings During the COVID-19 Pandemic.","authors":"Emily M Woltmann, Brianna Osorio, Christina T Yuan, Gail L Daumit, Amy M Kilbourne","doi":"10.18865/ed.DECIPHeR.105","DOIUrl":"10.18865/ed.DECIPHeR.105","url":null,"abstract":"<p><strong>Background: </strong>Persons with serious mental illnesses (SMIs) experience disparities in health care and are more likely to die from physical health conditions than the general population. Behavioral health homes are used in public sector mental health programs to deploy collaborative care to improve physical health for those with SMIs. During the COVID-19 pandemic, these programs faced new challenges in delivering care to this vulnerable group.</p><p><strong>Purpose: </strong>To describe barriers to implementing or sustaining behavioral health homes, experienced by community mental health workers during the COVID-19 pandemic, and the strategies used to address these challenges.</p><p><strong>Methods: </strong>In-depth qualitative interviews were conducted among the behavioral health workforce in Maryland and Michigan community mental health programs. Interview questions were derived from the Consolidated Framework for Implementation Research (CFIR), and responses related to implementing and sustaining health homes during the pandemic were coded and themes were analyzed by using an inductive approach.</p><p><strong>Results: </strong>Overall, 72 staff members across 21 sites in Maryland and Michigan were interviewed. Implementation barriers/strategies identified occurred across multiple CFIR domains (client, mental health system, physical health system). Interviewees discussed technologic and nontechnologic challenges as well as strategies to address technology issues. Strategies were more frequently discussed by providers when the barrier was viewed at the client level (eg, low technology literacy) versus the broader system (eg, canceled primary care visits).</p><p><strong>Conclusions: </strong>Community mental health staff described barriers beyond technology in caring for individuals with SMIs and physical health conditions. Further research should examine how implementation strategies address both technologic and nontechnologic barriers to collaborative care.</p>","PeriodicalId":50495,"journal":{"name":"Ethnicity & Disease","volume":"DECIPHeR Spec","pages":"105-116"},"PeriodicalIF":3.4,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and Facilitators to Improving Cardiovascular Health in Churches with Predominantly Black Congregations.","authors":"Ana Peralta-Garcia, Jodie Laurent, Alessandra N Bazzano, Marilyn J Payne, Andrew Anderson, Flor Alvarado, Keith C Ferdinand, Jiang He, Katherine T Mills","doi":"10.18865/ed.DECIPHeR.96","DOIUrl":"10.18865/ed.DECIPHeR.96","url":null,"abstract":"<p><strong>Objective: </strong>Black communities bear a disproportionate burden of cardiovascular disease (CVD). Barriers and facilitators for improving cardiovascular health (CVH) in churches with predominantly black congregations were explored through a qualitative needs assessment.</p><p><strong>Methods: </strong>Four focus groups with church members (n=21), 1 with wellness coordinators (n=5), and 1 with primary care providers (n=4) and 7 individual interviews with church leaders were completed in New Orleans and Bogalusa, Louisiana. Virtual, semistructured interviews and focus groups were held between October 2021 and April 2022. The Theorical Domains Framework (TDF) guided a framework analysis of transcribed data based on inductive and deductive coding to identify themes related to determinants of CVH.</p><p><strong>Results: </strong>The following four domains according to the TDF were identified as the most relevant for improving CVH: knowledge, professional role, environmental context, and emotions. Within these domains, barriers expressed by church leadership and members were a lack of knowledge of CVD, provider distrust, and little time and resources for lifestyle changes; facilitators included existing church wellness programs and social support, community resources, and willingness to improve patient-provider relationships. Primary care providers recognized a lack of effective communication and busy schedules as obstacles and the need to strengthen communication through increased patient autonomy and trust. Potential strategies to improve CVH informed by the Expert Recommendation for Implementing Change compilation of implementation strategies include education and training, task shifting, dissemination of information, culturally tailored counselling, and linkage to existing resources.</p><p><strong>Conclusions: </strong>These findings can inform the implementation of interventions for improving cardiovascular health and reducing disparities in black church communities.</p>","PeriodicalId":50495,"journal":{"name":"Ethnicity & Disease","volume":"DECIPHeR Spec","pages":"96-104"},"PeriodicalIF":3.4,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation Research at NHLBI: Methodological and Design Challenges and Lessons Learned from the DECIPHeR Initiative.","authors":"David M Murray, Patrick Heagerty, James Troendle, Feng-Chang Lin, Jonathan Moyer, June Stevens, Leslie Lytle, Xinzhi Zhang, Maliha Ilias, Mary Y Masterson, Nicole Redmond, Veronica Tonwe, Dave Clark, George A Mensah","doi":"10.18865/ed.DECIPHeR.12","DOIUrl":"10.18865/ed.DECIPHeR.12","url":null,"abstract":"<p><p>NHLBI funded seven projects as part of the Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Risk (DECIPHeR) Initiative. They were expected to collaborate with community partners to (1) employ validated theoretical or conceptual implementation research frameworks, (2) include implementation research study designs, (3) include implementation measures as primary outcomes, and (4) inform our understanding of mediators and mechanisms of action of the implementation strategy. Several projects focused on late-stage implementation strategies that optimally and sustainably delivered two or more evidence-based multilevel interventions to reduce or eliminate cardiovascular and/or pulmonary health disparities and to improve population health in high-burden communities. Projects that were successful in the three-year planning phase transitioned to a 4-year execution phase. NHLBI formed a Technical Assistance Workgroup during the planning phase to help awardees refine study aims, strengthen research designs, detail analytic plans, and to use valid sample size methods. This paper highlights methodological and study design challenges encountered during this process. Important lessons learned included (1) the need for greater emphasis on implementation outcomes, (2) the need to clearly distinguish between intervention and implementation strategies in the protocol, (3) the need to address clustering due to randomization of groups or clusters, (4) the need to address the cross-classification that results when intervention agents work across multiple units of randomization in the same arm, (5) the need to accommodate time-varying intervention effects in stepped-wedge designs, and (6) the need for data-based estimates of the parameters required for sample size estimation.</p>","PeriodicalId":50495,"journal":{"name":"Ethnicity & Disease","volume":"DECIPHeR Spec","pages":"12-17"},"PeriodicalIF":3.4,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11099519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}