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Context: Somali patients in the U.S. experience persistently low cervical cancer screening rates due to a complex mix of barriers. Primary care clinic-based HPV self-sampling could effectively increase cervical cancer screening rates in Somali women by positioning providers to address some key screening barriers, enabling clinics to opportunistically fit in HPV self-sampling in the clinical encounter, and providing an alternative modality for patients. Research to date has focused primarily on mailing HPV self-sampling kits to patients, and less is known about offering HPV self- sampling during the patient encounter in the primary care clinic setting. Objective: Primary care providers and staff were asked for their views on implementing HPV self-sampling in clinic. Findings will be used to inform an effectiveness-implementation study testing the impact of offering HPV self-sampling as an option for cervical cancer screening for Somali patients. Study Design: Primary care providers and staff participated in semi- structured interviews, exploring their views on HPV self-sampling and their anticipated needs or barriers to implementing this approach in the clinic setting and clinical encounter. The Consolidated Framework for Implementation Science (CFIR) was used to inform the interview guide. Analysis: Interviews were recorded and transcribed. A thematic analysis using the constructivist version of grounded theory was undertaken. Population Studied: 30 primary care providers and staff in two clinics in Minneapolis, Minnesota who serve large Somali patient populations. Results: Providers and staff anticipate positive patient reactions to the option of HPV self-sampling, although some voiced concern about patients perceiving HPV self-sampling as a less effective option, and worry about the lack of a physical exam. HPV self-sampling was mostly viewed favorably as a modality to help increase screening and was seen as straightforward to integrate into existing clinic workflows. Providers largely lacked awareness of the evidence supporting the accuracy of HPV self-sampling for cervical cancer screenings and felt clinic wide staff and patient education would be needed. Conclusions: HPV self-sampling in clinic was viewed favorably, particularly to reach under-screened populations, and was seen as being easy to implement in current workflows. Clinic-wide education on the current evidence on HPV self-sampling will be essential to support implementation., Presenters Rebekah Pratt, PhD, Rachel Winer, PhD, MPH, Adam Szpiro, John Lin, Timothy J. Ramer, MD, Christina Bliss Barsness, MPH, RD, Rahel Ghebre, Jay Desai, [...]

Context: Asian Americans are a diverse racial group, yet little research has described how adolescent tobacco use varies among Asian ethnic groups and how protective factors for tobacco use among general adolescent populations apply to these groups. Objective: To describe tobacco use patterns and protective factors in a statewide sample of Asian American adolescents by ethnicity. Setting/Dataset: 2019 Minnesota Student Survey. Population Studied: 8th, 9th, and 11th grade Asian Americans in Minnesota (n=10,482). Outcome measures: Dichotomized past 30-day use of cigarettes, cigars, e-cigarettes, hookah, chewing tobacco, dual/poly (>2), and any tobacco. Study Design & Analysis: Descriptive statistics examined tobacco use differences by ethnicity. Multivariable logistic regression modelled associations between 6 protective factors (internal developmental assets, positive student-teacher relationships, peer and parent anti-smoking norms, college aspirations, family caring) and e-cigarette use, adjusting for sex, grade, metro residence, and economic hardship. An interaction model (protective factor x ethnicity) assessed differences by ethnicity. Results: Among respondents, 9.0% identified as Indian, 0.3% Burmese, 7.9% Chinese, 2.5% Filipino, 25.0% Hmong, 3.2% Karen, 4.6% Korean, 2.7% Laotian, 8.2% Vietnamese, 7.5% other, 7.5% multiple Asian ethnicities, and 21.6% multiracial. E-cigarettes were the predominant form of tobacco use across groups. Laotian and multi-racial groups reported the highest e-cigarette use (16.6% and 16.3%), whereas Chinese and Asian Indian groups reported the lowest levels (4.7% and 5.0%). All 6 protective factors were significantly associated with lower odds of e-cigarette use across groups with significant interactions for internal developmental assets and peer anti-smoking norms. Higher developmental asset scores were associated with lower e-cigarette use in Asian Indian, Chinese, Hmong, Vietnamese, and multi-racial respondents. Peer antismoking norms were associated with lower e-cigarette use in Asian Indian, Chinese, Hmong, Vietnamese, and other respondents. Conclusions: E-cigarettes are the most prevalent tobacco product used by Asian adolescents in Minnesota. Protective factors from the general population appear to function similarly for these youth. Heterogeneity in e-cigarette use by ethnicity underscores the importance of disaggregating tobacco use by ethnicity to inform tailored tobacco prevention and control strategies., Presenters April Wilhelm, MD, MPH, Patrick Hammett, Steven Fu, Rebekah Pratt, PhD, Marla Eisenberg, Michele Allen, MD, MS, [...]

THE INNOVATION Despite Somali patients in Minnesota testing at a positivity rate of 23% for coronavirus disease 2019 (COVID-19), there is underutilization of testing and virtual health care technologies, creating [...]

Background and Objectives: The increased demand on providers from health care systems combined with the complex and difficult practice of medicine contributes to provider stress and burnout. In order to develop effective, sustainable interventions for provider burnout, it is important to understand the lived experiences of providers and their perceptions of its causative factors. We describe focus group findings that explore provider perceptions and offer suggestions for future actions.Methods: We convened six focus groups in five clinics involving 44 participants and used a common set of questions for each group. Real-time follow-up questions varied as needed to clarify or explore specific themes. We asked for descriptions of providers' daily work, their ability to complete that work, and the frustrations associated with accomplishing their tasks. In addition, providers were asked about transparency of decision making and their perceptions of control in the workplace.Results: Three major themes evolved from these focus groups: the perceived impact of the work environment, work tasks, and "e-stress."Conclusions: Our findings suggest three competing tensions contribute to provider burnout, none of which were attributable to patient volume or complexity. These tensions were described as originating from clinician experience of management practices and new requirements in the work environment, tension between direct patient care and non-direct patient care work tasks, and "e-stress" caused by the digital presence in providers' work lives. [ABSTRACT FROM AUTHOR]

Background: Racial/ethnic minority populations in the United States are consistently underrepresented in genetic research. Large‐scale public participation is required to ensure discoveries from precision medicine research are applicable to everyone. To evaluate views toward and facilitators of participation among minority populations in the United States, we conducted a systematic review of literature. Methods: Six databases were searched for articles published from 2005 to 2018 assessing minority populations' views and/or willingness to participate in genetic research. A thematic framework was applied to extracted data to synthesize findings, and the Socio‐Ecological Model was used to evaluate papers. Results: Review of 2,229 titles and abstracts identified 27 papers (n = 8 qualitative, n = 19 quantitative). Themes included knowledge of genetics, engagement in research, facilitators and barriers to participation, and cultural considerations. Understanding of genetics was low, yet the majority of participants were willing to participate in genetic research among all populations included in the literature (range: 57%–97%). Recommendations for research included utilizing community‐based participatory approaches, evaluating participants' informational needs, incentivizing participation, and providing direct benefits (e.g., genetic test results). Conclusion: Results could influence future study designs that incorporate all levels of the Socio‐Ecological Model and better meet the needs of underrepresented groups, thereby ensuring precision medicine research findings are applicable to all. [ABSTRACT FROM AUTHOR]

The prevalence of combustible cigarette smoking in populations experiencing homelessness in the United States is five times that of the general population. The psychosocial well-being of persons who smoke and experience homelessness is poorer if such persons also use alcohol heavily. The PTQ2 study was a randomized clinical trial among persons experiencing homelessness who were also current smokers and heavy alcohol consumers. Secondary data analysis of the PTQ2 baseline data was conducted to examine associations among psychosocial variables (anxiety, depression, hopelessness, social network size), heaviness of smoking (cigarettes/day) and alcohol consumption (drinking days/month), and duration and frequency of homelessness. Among the 420 participants, the majority were male (75%), black (70%) and non-Hispanic (94%) with a mean age of 46.6 years ( SD = 11.6).  Bivariate analyses show that heaviness of smoking was positively correlated with social network size ( r = 0.16, p = .001). Heaviness of drinking was positively correlated with the MINI anxiety score ( r = 0.13, p = .009) and marijuana use (median total number of drinks in past 30 days among those who used marijuana in past 30 days vs. did not use: 50 vs. 24, p < .0001), and associated with frequency of homelessness (median total number of drinks in past 30 days among those experiencing homelessness once vs. >1 time: 30 vs. 44, p = .022). The findings highlight the psychosocial factors that warrant consideration when addressing heavy smoking and alcohol consumption in persons experiencing homelessness., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Context: The Somali community in Minnesota has suffered a disproportionate impact of COVID-19. Engaging community members in COVID-19 patient centered outcome related research will be needed to find effective ways to address these disparities. However, COVID-19 disrupted usual methods of community engagement and research is needed to identify how to continue effective engagement. Objective: The Community Voices for Health study explored methods of community engagement and Somali patient and community member priorities for ongoing COVID-19 patient centered research. Study Design: We conducted a survey to engage community members for input on 1) preferred methods of community engagement to ensure broad reach in the community, 2) views on the priorities for COVID-19 related PCOR/CER topics, and 3) views on capacity building needed to support participation in patient centered research projects. Setting or Dataset: 40 Community Ambassadors were recruited to conduct a community-based survey. Population studied: 940 Somali adult patients and community members responded to the survey across the State of Minnesota. 55% identified as female. 77% of participants were born abroad. A range of ages, education levels and household size were represented Results: Survey participants were asked if they had been asked for their input on COVID-19 by any organization or institution and 23% (n=194) indicated they had been asked for their views and 77% (n=653) said they had not. The top three preferred methods of engagement were to participate in engagement by phone (n=533), text message (n=367) and socially distanced in person (n=227). Survey participants were provided with a list of 14 different topics relating to COVID-19, which were identified in collaboration with a Community Advisory Group. The top three topics considered a priority for future research in relation to COVID-19 were the care provided to Somali patients with COVID-19, ways to encourage prevention of COVID-19 and experiences of racism in the health system in seeking help for COVID-19 Conclusions: The Somali community in Minnesota is very engaged and keen to participate in community engagement when it is presented in a culturally relevant, trusted way. The survey was able to use methods that supported a reach across the state of Minnesota and is one of the most comprehensive engagement efforts conducted with the Somali community in Minnesota on any topic., Competing Interests: Authors report none., (2021 Annals of Family Medicine, Inc.)

Context: Care continuity during transitions between the hospital and home requires reliable communication between providers and settings and an understanding of social determinants that influence recovery., Case Description: The coordinating transitions intervention uses real time alerts, delivered directly to the primary care practice for complex chronically ill patients discharged from an acute care setting, to facilitate nurse care coordinator led telephone outreach. The intervention incorporates claims-based risk stratification to prioritize patients for follow-up and an assessment of social determinants of health using the Patient-centered Assessment Method (PCAM). Results from transitional care are stored and transmitted to qualified healthcare providers across the continuum., Findings: Reliance on tools that incorporated interoperability standards facilitated exchange of health information between the hospital and primary care. The PCAM was incorporated into both the clinical and informational workflow through the collaboration of clinical, industry, and academic partners. Health outcomes improved at the study practice over their baseline and in comparison with control practices and the regional Medicaid population., Major Themes: Current research supports the potential impact of systems approaches to care coordination in improving utilization value after discharge. The project demonstrated that flexibility in developing the informational and clinical workflow was critical in developing a solution that improved continuity during transitions. There is additional work needed in developing managerial continuity across settings such as shared comprehensive care plans., Conclusions: New clinical and informational workflows which incorporate social determinant of health data into standard practice transformed clinical practice and improved outcomes for patients.

The main aim of this research was to assess the relevance and impact of wellness recovery action planning (WRAP) as a tool for self-management and wellness planning by individuals with mental health problems from pre-existing and newly formed groups, where the possibilities for continued mutual support in the development of WRAPs could be explored. Interviews and focus groups were conducted and pre-post recovery outcome measures completed (Recovery Assessment Scale and Warwick Edinburgh Mental Well Being Scale). 21 WRAP group participants took part in the research. The WRAP approach, used in groups and delivered by trained facilitators who could also share their lived experience, was very relevant and appeared to have a positive impact on many of the participants. The impact on participants varied from learning more about recovery and developing improved self-awareness to integrating a WRAP approach into daily life. The apparent positive impact of WRAP delivered in the context of mutual support groups indicates that it should be given serious consideration as a unique and worthwhile option for improving mental health. WRAP groups could make a significant contribution to the range of self-management options that are available for improving mental health and well-being.