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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]

The "Domestic Violence and Minoritization: Supporting women to independence" project was jointly funded by the European Social Fund and Manchester Metropolitan University. The study was carried out in Manchester, England. The research considered the issues of minoritization and domestic violence through exploring the views of service providers and survivors of abuse. The project also had an intervention phase with group work being offered to women who had left a violent relationship. The discussion in this article presents some of the findings from the Domestic Violence and Minoritization project.

Self-collected testing for human papillomavirus (HPV) is poised to transform cervical cancer screening. Self-tests demonstrate similar accuracy to clinician-collected tests, but for the half a million women served by the Veterans Health Administration (VA) and their clinicians, self-collected cervical cancer screening would be a new practice. We examined VA patient and staff perspectives to inform future implementation. Semi-structured telephone interviews were conducted between 2021 and 2022 with female veterans receiving VA care (n = 22) and VA women's health nurses, clinicians, and administrators (n = 27). Interviews were audio-recorded and transcribed. Interview questions addressed knowledge and interest, potential advantages or disadvantages, and any questions participants had about self-collected screening. Responses were analyzed using rapid qualitative methods. Five overarching themes were identified. Both patients and staff indicated high interest and enthusiasm for self-collected HPV testing, tempered by questions about test accuracy and logistical considerations. Familiarity with self-testing for other conditions such as colon-cancer screening or COVID made self-collection seem like a simple, convenient option. However, self-testing was not viewed as a good fit for all patients, and concerns about lost opportunities or missed incidental lesions were raised. Patients and staff described challenges with pelvic examinations for patients with past sexual trauma, particularly in the male-dominated VA environment. Pelvic exams can leave patients feeling vulnerable and exposed; self-collected testing was seen as a mechanism for patient empowerment. Veteran patients and VA staff shared common perspectives about potential advantages and disadvantages of self-collected HPV testing. Self-collected HPV testing has the potential to improve trauma-informed preventive health care for veterans. [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]

Background Interventions in food pantry settings have the potential to improve health among clients at risk of diet-related disease. Purpose This study evaluates whether a cluster-randomized, behavioral intervention in food pantries resulted in improved client outcomes. Methods Sixteen Minnesota food pantries were randomized to an intervention (n = 8) or control condition (n = 8). The intervention offered pantries technical assistance to improve healthy food supply and implement behavioral economics strategies to promote healthy food selection. A convenience sample of adult clients were enrolled (paired sample, 158 intervention, 159 control) and followed for 1 year. Additional clients were enrolled at follow-up to assess food selection (follow-up sample, 85 intervention, 102 control). Analysis was limited to data from 11 pantries (5 intervention, 6 control) due to COVID-19. Outcome measures included Healthy Eating Index-2015 (HEI-2015) total and subcomponent scores for 24-hr dietary recalls and client cart selections, and Life's Simple 7 (LS7) total and subcomponent scores. Multilevel mixed-effects models tested whether client outcomes differed by intervention condition. Results In adjusted models, there were no statistically significant differences by intervention condition in HEI-2015 or LS7 scores. Clients in intervention food pantries had improved Refined Grain subcomponent scores (p =.004); clients in control pantries had worsened Saturated Fat subcomponents scores (p =.019) and improved physical activity scores (p =.007). Conclusions The intervention did not result in improved diet quality or cardiovascular health as measured by HEI-2015 or LS7. Coordinated efforts across settings are needed to address health risks facing this population. [ABSTRACT FROM AUTHOR]

Prolonged stress is a risk factor for the development of mental health problems. This is particularly concerning among immigrant communities because many experienced multiple stressful life events. This study aimed to gain better understanding about attitudes toward mental health and addition, and perspectives about health research among Somali immigrants. Eight focus groups (n = 47) were conducted in the Twin Cities, Minnesota. Comprehensive notes were taken during the session and were translated into English. An open-coding method was used to identify general patterns of responses. Stress, personal commitment, and stigma were related to mental health and addiction. There were gender and generational differences in ideas about addiction. Health research was perceived as acceptable under culturally appropriate conditions. This study provided novel information about mental health and addiction as well as the feasibility of research on mental health and addiction in East African communities. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to develop and test feasibility of a colorectal cancer (CRC) education video appropriate for Somali immigrants. Design: One-group pretest–posttest design. Setting: Minneapolis, MN. Sample: Thirty-one Somali men (mean age = 60.6; SD = 13.0). Intervention: A CRC education video was developed in the Somali language with Somali community partners. Participants were invited to a workshop and watched the video. Measures: Levels of understanding about CRC and screening were assessed before vs after the video. Analysis: Binomial tests were conducted to examine changes in level of understanding. Results: Analysis on pre–post, within-person changes in understanding about cancer, and CRC screening showed that proportions with a positive change in understanding risks of cancer (80%) and benefits of CRC screening (90%) were significantly higher than expected if the video had no effect (50%; P =.012, P <.001, respectively). Ninety-three percent of participants agreed that the video contained useful information. Conclusion: These results provide evidence of usefulness of culturally tailored videos to facilitate CRC screening in the Somali community. Results of this study were limited by a small sample size and lack of a control group. [ABSTRACT FROM AUTHOR]

Food pantry clients are at a high risk for diet-related chronic disease and suboptimal diet. Relatively little research has examined diet quality measures in choice-based food pantries where clients can choose their own food. This study tested whether the diet quality scores for food at the pantry were associated with client food selection scores, and whether client food selection scores at the pantry were associated with client diet intake scores. This cross-sectional regression analysis, part of a larger evaluation study (SuperShelf), used baseline data from client and food pantry surveys, food pantry inventories, assessments of client food selections ("client carts"), and single 24-hour client dietary recalls. The analysis includes 316 clients who completed a survey (282 of whom completed a dietary recall measure) from one of 16 choice-based Minnesota food pantries during 2018-2019. Adult English, Spanish, or Somali-speaking clients were eligible in the case that they had selected food on the day of recruitment at their food pantry visit. A Healthy Eating Index-2015 (HEI-2015) Total score and 13 subcomponent scores were calculated for: pantry food inventories of food available on the shelf, client carts, and a 24-hour client dietary recall. Descriptive statistics were generated for client and food pantry characteristics, and for HEI-2015 Total score and subcomponent scores. Linear regression models tested the association between HEI-2015 Total score and subcomponent scores for food pantry inventory and client carts, and for client carts and dietary recalls, adjusted for covariates. Food pantry inventory HEI-2015 Total score averaged 65.1, client cart Total score averaged 60.8, and dietary recall Total score averaged 50.9. The diet quality scores for inventory were not associated with client cart scores, except for Added Sugars (P =.005). Client cart HEI-2015 Total score was positively associated with client diet HEI-2015 Total score (P =.002) and associations for Total Fruits, Whole Fruits, Total Vegetables, Greens and Beans, Whole Grains, Seafood and Plant Proteins, and Added Sugars subcomponents were statistically significant. In choice-based Minnesota food pantries, the diet quality of food selected by clients was positively associated with client diet quality. [ABSTRACT FROM AUTHOR]

Abstract Objective Use Normalization Process Theory to evaluate the implementation and integration of the expanded School Breakfast Program (SBP). Design Interviews were conducted during the 2014–2015 school year. Normalization Process Theory guided the interview questions. Setting Rural high schools in Minnesota. Participants Interviews were conducted with 12 foodservice directors and 11 principals from the Project Break–Fueling Academics and Strengthening Teens intervention. Four of the 12 schools were in their first year of providing the expanded SBP program to their students whereas 8 were in their second year. Phenomenon of Interest Normalization Process Theory was used to evaluate the implementation and integration of the expanded SBP into rural Midwestern high schools. Analysis Three members of the research team used NVivo 10 software to code and analyze the interviews. Emerged themes were reported. Results Modifying the SBP aligned with values of the study participants (coherence). Support was obtained from staff, students, and community members (cognitive participation). Operational work occurred in each school to establish and integrate the modified SBP (collective action). The SBP expansion was assessed through student participation rates (reflexive monitoring). Conclusions and Implications Normalization Process Theory can be used to evaluate the implementation, embedding, and integration of a modified SBP into a school program. This evaluation can support other schools in modifying and embedding their SBPs into their school environment. [ABSTRACT FROM AUTHOR]

• Disaggregating e-cigarette use by Asian ethnicity shows significant heterogeneity. • Asian adolescents with more developmental assets are less likely to use e-cigs. • Anti-smoking peers and positive teacher engagement may also reduce e-cig use. This study characterized variation in e-cigarette use patterns and related protective factors by ethnicity among Asian American adolescents. Multivariable logistic regressions modelled associations between ethnic group, 6 protective factors (college aspirations, internal developmental assets, positive teacher engagement, family caring, and peer and parent anti-smoking norms), and past 30-day e-cigarette use, adjusting for covariates among 10,482 8th, 9th, and 11th grade Asian American respondents to the 2019 Minnesota Student Survey. Interaction terms (protective factor × ethnic group) were used in 6 subsequent regression models to examine whether the association between each protective factor and e-cigarette use differed as a function of ethnic group. Respondents included 9.0% 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% multi-ethnic, and 21.6% multi-racial adolescents. E-cigarettes were the predominant form of tobacco use. Laotian and multi-racial groups reported the highest e-cigarette use (16.6% and 16.3%), whereas Chinese and Asian Indians reported the lowest (4.7% and 5.0%). Strong peer anti-smoking norms, higher internal developmental assets scores, and positive teacher engagement were associated with lower odds of e-cigarette use across groups, with significant interactions for internal developmental assets by ethnicity. E-cigarettes are the most prevalent tobacco product used by Asian adolescents in Minnesota, with notable heterogeneity by ethnicity. While most established protective factors appeared to function similarly for Asian adolescents, others differed, underscoring the importance of disaggregating data by ethnicity to inform the tailoring of prevention and control strategies for these ethnic groups. [ABSTRACT FROM AUTHOR]

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, ecigarettes, 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 studentteacher relationships, peer and parent anti-smoking norms, college aspirations, family caring) and ecigarette 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 ecigarette 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. [ABSTRACT FROM AUTHOR]

Introduction: Colorectal cancer (CRC) is the third most-diagnosed cancer among men and women in the US. This study aimed to evaluate the influence of an interactive inflatable colon exhibit on CRC knowledge and screening intent among men attending state fairs in 2 midwestern states., Methods: At the 2023 state fairs in 2 midwestern states, eligible participants (men aged 18-75 y who could speak and read English and resided in 1 of the 2 states) completed a presurvey, an unguided tour of the inflatable Super Colon, and a postsurvey. Primary outcomes were changes in knowledge (actual and perceived) and CRC screening intent from presurvey to postsurvey. We used χ 2 tests to examine differences in survey results between the 2 sites and the association between demographic characteristics and behaviors (knowledge and intentions) before entering the Super Colon exhibit. We used the McNemar test to examine differences in presurvey to postsurvey distributions., Results: The study sample (N = 940) comprised 572 men at site A (60.8%) and 368 men at site B (39.2%). Except for 1 question, baseline CRC knowledge was relatively high. Greater perceived knowledge was inversely associated with greater actual knowledge. After touring the Super Colon, participants improved their actual knowledge of CRC prevention and self-perceived CRC knowledge. Most participants (95.4%) agreed that the Super Colon was effective for teaching people about CRC., Conclusion: These findings emphasize the role of community-based educational initiatives in encouraging CRC screening uptake and increasing research participation among men and affirm that the inflatable colon is as an effective educational tool for increasing CRC knowledge and encouraging early-detection screening behavior among men.

Genetic counseling outcomes are influenced by the processes and strategies used by counselors, yet little is known about how these strategies directly impact patients and populations. In particular, tailoring genetic counseling consultations to best meet the needs of cultural, racial, and ethnically diverse populations has been explored. This review aims to identify genetic counseling strategies tailored for a diversity of racial and ethnic populations with the goal to find ways to improve genetic counseling outcomes. Medline, Cochrane CENTRAL, Embase, PsychInfo, and CINAHL databases were searched for original research articles published in English that employed genetic counseling processes and strategies to improve genetic counseling outcomes, specifically for participants from ethnically or racially diverse populations. A review of 5300 titles and abstracts resulted in the identification of 36 articles that met the inclusion criteria. Three themes emerged: (1) community involvement in culturally tailoring genetic counseling, (2) creation and use of culturally tailored resources, and (3) modifications to the genetic counseling process. The effectiveness of genetic counseling strategies could not be evaluated due to lack of consistent outcome measures in the articles. The involvement of diverse ethnic and racial populations in developing inclusive genetic counseling tools and practices will help the profession provide better patient care in the future. More research connecting genetic counseling processes and outcomes will help to assess how well these modified approaches meet the needs of diverse populations., (© 2023 The Authors. Journal of Genetic Counseling published by Wiley Periodicals LLC on behalf of National Society of Genetic Counselors.)

Discrimination is detrimental to health. Little is known about perceived discrimination among Somali immigrants. We examined whether age or proportion of lifetime in the United States was associated with perceived discrimination among Somali immigrants. Guided by Intersectionality, we described a secondary analysis of Everyday Discrimination Scale (EDS) survey data from the Healthy Immigrant Community study. Younger participants ( ≤40 years) experienced more discrimination than older participants ( >40 years). Higher education, being male, and earning $20,000-$39,999 was associated with more perceived discrimination. These findings suggest that Somali immigrants who are younger, more formally educated, male, and/or earn $20,000-$39,000 report more discrimination than their counterparts. Possible explanations include exposure to discrimination outside the Somali community or more awareness about racism. Alternatively, the EDS may not capture the discrimination experienced by Somali women or older adults. Further research is needed to address the discrimination experienced by Somali immigrants. Clinical Trial Registration: NCT05136339, November 29,2021., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Nutrition promotion programs may have varying effects and influence health disparities. SuperShelf promotes healthy choices in food pantries through inventory changes and nudge implementation (e.g., choice architecture). This secondary analysis of the SuperShelf cluster-randomized trial assessed whether the effect of SuperShelf on client diet quality differed by equity characteristics. English-, Spanish-, or Somali-speaking adult clients from 11 food pantries in Minnesota were included (N = 193). We measured change in diet quality by the Healthy Eating Index 2015 (HEI-2015; maximum score 100) using up to two 24 h dietary recalls from pre-intervention and post-intervention periods. We used linear mixed-effects models to determine whether the effect of SuperShelf on diet quality varied by self-reported gender, race/ethnicity, education, and employment status. In separate adjusted models, the interactions of SuperShelf and gender, education, or employment status were not significant. The interaction of SuperShelf and race/ethnicity was significant ( p -interaction = 0.008), but pairwise comparisons in diet quality were non-significant in all racial/ethnic subgroups. SuperShelf did not have differential effects on diet quality by gender, race/ethnicity, education, or employment status, suggesting it does not worsen dietary disparities among food pantry clients, though more subgroup analyses are needed to explore potential racial/ethnic disparities in this context.

Genetic counseling research requires a comprehensive approach since it frequently serves as the foundation for clinical care practice. Genetic counseling students play a pivotal role in advancing the profession, as they contribute a significant proportion of the research conducted within the genetic counseling community. However, a prevailing trend of convenience sampling of genetic counselors has limited the diversity of perspectives in student research projects. This article promotes a strategy for greater inclusivity and equity in research by emphasizing community-engaged and empowered research through the perspective of restorative justice. Reflecting on the shadow of the harmful ideologies of eugenics in our profession underscores the need to amplify patients' voices and diverse experiences. Community-engaged research-in collaboration with individuals, families, and communities directly impacted by genetic counseling-transcends traditional research paradigms, empowering patients and addressing systemic inequities. Incorporating community-engaged research into genetic counseling student projects aims to empower future professionals to better understand patient perspectives and needs while working toward addressing historical injustices. This article explores the potential benefits and pathways of incorporating community-engaged research and restorative justice principles into genetic counseling scholarly work, promoting empathy, cultural responsiveness, and ultimately, a more patient-centered approach to research and clinical care. By embracing this collective journey toward authentic partnership in the production of high-quality evidence in genetic counseling student research and more broadly, genetic counseling can become a more just and inclusive practice., (© 2024 The Authors. Journal of Genetic Counseling published by Wiley Periodicals LLC on behalf of National Society of Genetic Counselors.)

Human papillomavirus (HPV) self-collect shows promise to increase cervical cancer screening rates in underscreened populations, such as Somali patients, but little is known about how to integrate such an approach in primary care. In this study, primary care providers and staff who provide primary care services to Somali women were asked for their views on integrating HPV self-collect into routine care to address cervical cancer screening disparities. Thirty primary care providers and staff participated in semi-structured interviews exploring their views on HPV self-collect and their anticipated needs or barriers to implementing this approach into the clinic generally and with specific patient populations, such as Somali women. A thematic analysis using the constructivist version of grounded theory was undertaken. Providers and staff anticipate positive patient reaction to the option of HPV self-collect, and were interested in using this approach both for Somali patients and for all patients in general. HPV self-collect was viewed as straightforward to integrate into existing clinic workflows. Providers largely lacked awareness of the evidence supporting primary HPV testing and HPV self-collect specifically, sharing concerns about effectiveness of self-collect and the lack of a physical exam. Providers felt clinic-wide staff education and patient education, along with strategies to address disparities, such as cultural and linguistic tailoring would be needed for successful implementation. Integrating HPV self-collect as an option in the cervical cancer screening process in a primary care clinical encounter offers considerable opportunity to address health disparities and may benefit all patients., 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., (© 2024 The Authors. Published by Elsevier Inc.)

We conducted interviews with parents earning low wages to understand their experiences related to financial responsibilities and use of government and informal resources in Raleigh, North Carolina. Inadequate economic opportunities and assistance programs, and high costs of living, compounded into cycles of playing catch up on expenses. Assistance programs aimed at alleviating hardships related to poverty were described as piecemeal. We found that social and economic systems failed to support parents earning low wages. Our findings suggest that ordinances that assure a livable minimum wage paired with expansions of safety net programs could better meet the needs these parents.

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.)

Background: Implementation science (IS) frameworks, models and theories (FMTs) have gained popularity in guiding the implementation and evaluation of evidence-based interventions (EBIs) for cancer screening. However, there are significant research gaps in understanding their applications in cancer health disparities contexts. This paper outlines a scoping review protocol designed to explore the utilisation of IS FMTs in cancer screening EBIs to inform intervention designs and adaptations., Methods and Analysis: This scoping review protocol adheres to Arksey and O'Malley's five-step methodological framework for conducting scoping studies. Search strategies were conducted in five bibliographic databases: Ovid MEDLINE, PubMed, Scopus, Web of Science and EMBASE. The search was run on 22 June 2023 with an English language filter and a date limit of 2001-current. Two reviewers will independently screen studies for inclusion and exclusion criteria. A third reviewer will be consulted, where appropriate at any of the review stages, to achieve consensus or resolve conflicts. Data will be collected, managed and analysed using Covidence. A narrative synthesis, based on Popay et al 's methodology, will guide reporting and summarisation of results. The review will adhere to the PRISMA Extension for Scoping Reviews guidelines., Ethics and Dissemination: This scoping review is a novel approach for examining a growing corpus of research literature on IS FMT applications used in cancer screening EBIs. As a secondary analysis, this scoping review does not require approval from an institutional review board. We anticipate the review will produce insightful information (eg, challenges, key areas for future directions) on the applications of IS TMFs in designing, deploying and testing EBIs for populations experiencing cancer screening disparities. We will disseminate the results through journals and conferences targeting IS and cancer prevention researchers and practitioners., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Pap tests are still underutilized by minority women due to limited awareness of cervical cancer screening (CCS), inadequate health care access, and cultural or religious beliefs. Human papillomavirus (HPV) self-sampling, a new CCS tool, has demonstrated potential to overcome some of these barriers. In 2021, women aged 30-65 years old were recruited across Minnesota to complete an online survey. The survey assessed five outcome measures related to HPV self-sampling: (1) awareness of test; (2) self-efficacy to conduct test; (3) location preference of test (clinic vs. home); 4) collector preference (self vs. clinician); and (5) preference of CCS strategy (HPV self-sampling vs. Pap test). Modified Poisson regressions tested associations between sociodemographic variables and outcomes. A total of 420 women completed the survey, of which 32.4% identified as Non-Hispanic white, 22.2% as Hispanic, 12.6% as Black/African-American, 28.3% as Asian, 1.9% as American Indian/Alaskan Native, and 1.4% as more than two races. Few women had heard of HPV self-sampling (6.5%), but a majority reported high self-efficacy to perform self-sampling (75.3%). Women also reported higher preferences for completing an HPV test in the clinic (52.2%) and for performing a self-collected HPV test themselves (58.7%), yet would choose a traditional Pap test over HPV self-sampling (56.0%). The low level of HPV self-sampling awareness, across all racial/ethnic groups, suggests a strong opportunity to promote widespread educational efforts around this new tool. Future HPV self-sampling research efforts should examine educational interventions targeted at healthcare providers to educate and encourage women on the importance of self-collection options., 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 Author(s).)

Background: Persistent infection with high-risk human papillomavirus (hrHPV) types is a well-documented cause of cervical cancer. Since the implementation of cervical cancer screening methods (e.g., Pap tests), cervical cancer rates have declined. However, Pap tests are still unacceptable to many women and require complex infrastructure and training. Self-sampling techniques for collecting HPV specimens (or "HPV self-sampling") have been proposed as a possible alternative to overcome these barriers. The objective of this study was to capture perspectives from health care personnel (providers, leaders, and clinic staff) across primary care systems on the potential implementation of an HPV self-sampling practice., Methods: Between May and July 2021, a study invitation was emailed to various health care professional networks across the Midwest, including a snowball sampling of these networks. Eligible participants were invited to a 45-60-min Zoom-recorded interview session and asked to complete a pre-interview survey. The survey collected sociodemographics on age, occupation, level of educational attainment, race/ethnicity, gender, and awareness of HPV self-sampling. The semi-structured interview was guided by the Consolidated Framework for Implementation Research and asked participants about their views on HPV self-sampling and its potential implementation. All interviews were audio-recorded, transcribed, and analyzed using NVivo 12., Results: Key informant interviews were conducted with thirty health care personnel-13 health care providers, 6 clinic staff, and 11 health care leaders-from various health care systems. Most participants had not heard of HPV self-sampling but reported a general enthusiasm for wanting to implement it as an alternative cervical cancer screening tool. Possible barriers to implementation were knowledge of clinical evidence and ease of integration into existing clinic workflows. Potential facilitators included the previous adoption of similar self-sampling tools (e.g., stool-based testing kits) and key decision-makers., Conclusion: Although support for HPV self-sampling is growing, its intervention's characteristics (e.g., advantages, adaptability) and the evidence of its clinical efficacy and feasibility need to be better disseminated across US primary care settings and its potential adopters. Future research is also needed to support the integration of HPV self-sampling within various delivery modalities (mail-based vs. clinic-based)., (© 2022. The Author(s).)

Objective: Standardized processes have evolved in response to the opioid epidemic. The impact of standardized processes on patients has not been adequately described., Methods: Five focus groups were held at four affiliated academic family medicine clinics. All participants experienced a transition to a standardized process for their ongoing opioid use for chronic, non-cancer pain. Data was analyzed and coded using a grounded theory approach with NVivo12 (QSR International)., Results: Thirty patients participated. Five main themes emerged: experience of pain; view of opioid medications; view of opioid prescribing process changes; "good patients" and trust; and experience with medical clinicians and clinics., Conclusions: Standardized processes created to improve the safety of opioid prescribing have burdened patients and resulted in a loss of trust and autonomy. Patients perceived greater risks for other patients prescribed opioids and processes are a result of their actions., Practice Implications: Healthcare systems must acknowledge patients' burden, shift away from interventions that are limited in supporting data, reinforce patient agency and shift the conversation to unsafe medications rather than supervision of "bad actors"., (Copyright © 2022. Published by Elsevier B.V.)