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Background Use of daily oral HIV pre-exposure prophylaxis (DO PrEP) has increased steadily in the past several years, but patterns of racial disparities have emerged in PrEP uptake. Although Black and Hispanic people are disproportionately affected by HIV in the US, they constitute a minority among those accessing DO PrEP. Newly available prevention options, such as long-acting injectable (LA) PrEP may help close the gap in unmet need for PrEP; however, interest in LA PrEP has not been evaluated specifically among racial/ethnic minority groups. Awareness, willingness, and usage of PrEP as well as HIV prevention preferences were assessed among sexually active adult men in the US. Methods Participants were recruited through a geographically targeted social media campaign and completed a self-administered, cross-sectional, online survey on demographics, sexual health and behavior, healthcare access, PrEP awareness and usage, and PrEP intention and preferences. Eligible participants met the following criteria: cisgender men, self-identified Black race and/or Hispanic ethnicity, 18 years or older, reporting unknown or HIV-negative status, currently residing in the US, and reporting anal or vaginal sex in the past six months. Descriptive statistics were calculated using SAS v9.4. Results From November to December 2021, 1365 men completed the survey (median age: 29.0 years; Black non-Hispanic: 43.1%, Black Hispanic: 40.3%, White Hispanic: 10.2%, Other Hispanic: 6.4%). A majority had heard of DO PrEP (66.6%) and LA PrEP (47.5%) as a way to prevent HIV; however, a smaller proportion had spoken to a healthcare provider (HCP) about PrEP (42.1%), had ever used PrEP (24.7%), or were currently taking PrEP (16.3%) (Figure 1). A large majority (74.0%) reported interest in using LA PrEP. When asked about their preferred PrEP option, 60.2% chose LA PrEP and 7.4% chose DO PrEP, while 27.5% stated that they preferred neither PrEP option. Figure 1.PrEP Awareness, Discussion with HCP, and Usage Among US Black and Hispanic Men, Overall and by Race/Ethnicity Conclusion Most participants demonstrated high awareness of PrEP and a strong interest in LA PrEP. The availability of and interest in LA PrEP may serve as an opportunity to help increase overall PrEP uptake among Black and Hispanic men in the US. Disclosures TONIA POTEAT, PhD, MPH, PA-C, ViiV Healthcare: Advisor/Consultant Supriya Sarkar, PhD, MPH, ViiV Healthcare: Salary|ViiV Healthcare: Stocks/Bonds Leigh Ragone, MS, GlaxoSmithKline: Stocks/Bonds|ViiV Healthcare: Employment Keith Rawlings, MD, ViiV Healthcare: Employee Alex R. Rinehart, PhD, ViiV Healthcare: Stocks/Bonds Vani Vannappagari, MBBS, MPH, PhD, ViiV Healthcare: I am full time employee of ViiV Healthcare and receive GlaxoSmithKline stock as part of my compensation package|ViiV Healthcare: Stocks/Bonds.

Background Cisgender women continue to have low pre-exposure prophylaxis (PrEP) uptake in the US, despite making up almost 20% of new HIV infections. The gap between the number of women who would benefit from PrEP and those who use PrEP highlights the unmet need for HIV prevention in women. As new prevention options, such as long-acting (LA) injectable PrEP, become available, it is important to understand PrEP awareness and preferences among women to help meet this need. Awareness, willingness, and usage of PrEP as well as HIV prevention preferences were assessed among sexually active women in the US. Methods Cisgender women were recruited through a geolocation targeted social media campaign and completed a self-administered, cross-sectional, online survey on demographics, sexual health and behavior, healthcare access, PrEP awareness and history, and PrEP intention and preferences. Eligible participants were cisgender women, 18 years or older, who reported an unknown or HIV-negative status, currently resided in the US, and reported vaginal or anal sex in the past six months. Descriptive statistics were calculated using SAS v9.4. Results From November to December 2021, 961 participants completed the survey (median age: 28.0 years; Black non-Hispanic: 34.7%; Black Hispanic: 19.9%; White non-Hispanic: 21.3%; White Hispanic: 12.0%; Another race: 9.1%). A majority had heard of PrEP (70.6%) and LA PrEP (50.1%) as a way to prevent HIV; however, a smaller proportion had spoken to a healthcare provider (HCP) about PrEP (37.8%), had ever used PrEP (19.7%), or were currently on PrEP (9.3%). While PrEP awareness was high across all racial and ethnic groups, PrEP discussions with an HCP and PrEP usage was lowest among Black, non-Hispanic women (Figure 1). Most participants (78.8%) expressed intent to regularly use any HIV prevention method and 66.0% reported likelihood of using LA PrEP if it were available. Condoms were the most favored prevention option (46.7%) followed by HCP administered LA PrEP (24.3%), vaginal ring (9.0%), self-administered LA PrEP (8.8%), and oral PrEP (6.7%). Conclusion Although most women demonstrated high PrEP awareness and interest, many had never discussed PrEP with an HCP. The availability of LA PrEP may be an important opportunity for HCPs to discuss a preferred PrEP option with women. Disclosures Tonia Poteat, PhD, MPH, PAC, Merck & Co. Inc: Advisor/Consultant|Viiv Healthcare: Advisor/Consultant Supriya Sarkar, PhD, MPH, ViiV Healthcare: Salary|ViiV Healthcare: Stocks/Bonds Leigh Ragone, MS, GlaxoSmithKline: Stocks/Bonds|ViiV Healthcare: Employment Keith Rawlings, MD, ViiV Healthcare: Employee Alex R. Rinehart, PhD, ViiV Healthcare: Stocks/Bonds Vani Vannappagari, MBBS, MPH, PhD, ViiV Healthcare: I am full time employee of ViiV Healthcare and receive GlaxoSmithKline stock as part of my compensation package|ViiV Healthcare: Stocks/Bonds.

Dorothee Oberdhan,1 Elizabeth Bacci,2 Jennifer N Hill,3 Andrew Palsgrove,1 Asha Hareendran3 1Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, MD, USA; 2Evidera, Seattle, WA, USA; 3Evidera, Bethesda, MD, USACorrespondence: Dorothee Oberdhan, Tel +1-301-424-9055, Email dorothee.oberdhan@otsuka-us.comPurpose: To identify concepts important to understanding the experiences of adults with focal onset seizures (FOS) and evaluate clinical outcome assessments (COAs) for measuring these concepts in clinical trials of treatments for FOS.Methods: A search of published qualitative research, clinical trials, and approved product labels for FOS treatments was performed to develop a conceptual disease model (CDM) of patients’ experience of living with FOS. Concepts of interest (COI) were selected, and a second literature search was conducted to identify COAs measuring these concepts. Ten COAs were selected and reviewed to document their development process, evidence of measurement properties, and methods for interpreting change scores using criteria proposed in regulatory guidelines for patient-reported outcomes to support label claims.Results: Concepts identified from the published literature (13 articles, 1 conference abstract), 24 clinical trials, and 8 product labels were included in a novel CDM. Impacts on physical, cognitive, and social and emotional function were chosen as COI for evaluating treatment outcomes for FOS; the additional concept of social support and coping strategies was chosen to understand patients’ lived experiences. From 51 unique COAs identified, 10 were selected based on their potential coverage of the COI; some symptom severity and health-related quality of life (HRQoL) COAs covered multiple COI. Of these 10, 8 COAs evaluated impacts/limitations on physical function, 8 measured social and emotional impacts, and 5 assessed social support and coping strategies. While most assessments had gaps in evidence validating their measurement properties, 2 COAs measuring symptom severity and 1 COA measuring HRQoL had evidence confirming their potential utility in clinical trials to support label claims.Conclusion: This research provides insights into the experience of patients with FOS and identifies COAs that measure concepts considered to support endpoints in clinical trials for FOS.Keywords: patient-centered outcomes, epilepsy, conceptual framework

Objective To describe current practices used by Veterans Administration (VA) mental health (MH) providers involved in post-traumatic stress disorder (PTSD) treatment planning to support engagement of veterans with PTSD in shared decision-making (SDM). Methods Semi-structured interviews with MH providers (n = 9) were conducted at 1 large VA, audio-recorded, and transcribed verbatim. Transcripts were analyzed deductively, guided by a published account of the integral SDM components for MH care. Results While discussing forming a cohesive team with patients, providers noted the importance of establishing rapport and assessing treatment readiness. Providers’ clinical knowledge/expertise, knowledge of the facility’s treatment options, knowledge of how to navigate the VA MH care system, and patient factors (goals/preferences, factors influencing treatment engagement) were noted as important to consider when patients and providers exchange information. When negotiating the treatment plan, providers indicated that conversations should include treatment recommendations and concurrent opportunities for personalization. They also emphasized the importance of discussions to finalize a mutually agreeable patient- and provider-informed treatment plan and measure treatment impact. Conclusion These results offer a preliminary understanding of VA MH providers’ facilitation of SDM for PTSD care. Findings may provide insights for MH providers who wish to engage patients with PTSD in SDM.

Background Patient-centred care is now ubiquitous in health services research, and healthcare systems are moving ahead with patient-centred care implementation. Yet, little is known about how healthcare employees, charged with implementing patient-centred care, conceptualize what they are implementing. Objective To examine how hospital employees conceptualize patient-centred care. Research design We conducted qualitative interviews about patient-centred care during site four visits, from January to April 2013. Subjects We interviewed 107 employees, including leadership, middle managers, front line providers and staff at four US Veteran Health Administration (VHA) medical centres leading VHA's patient-centred care transformation. Measures Data were analysed using grounded thematic analysis. Findings were then mapped to established patient-centred care constructs identified in the literature: taking a biopsychosocial perspective; viewing the patient-as-person; sharing power and responsibility; establishing a therapeutic alliance; and viewing the doctor-as-person. Results We identified three distinct conceptualizations: (i) those that were well aligned with established patient-centred care constructs surrounding the clinical encounter; (ii) others that extended conceptualizations of patient-centred care into the organizational culture, encompassing the entire patient-experience; and (iii) still others that were poorly aligned with patient-centred care constructs, reflecting more traditional patient care practices. Conclusions Patient-centred care ideals have permeated into healthcare systems. Additionally, patient-centred care has been expanded to encompass a cultural shift in care delivery, beginning with patients' experiences entering a facility. However, some healthcare employees, namely leadership, see patient-centred care so broadly, it encompasses on-going hospital initiatives, while others consider patient-centred care as inherent to specific positions. These latter conceptualizations risk undermining patient-centred care implementation by limiting transformational initiatives to specific providers or simply repackaging existing programmes.

Data were collected via a cross-sectional mailed survey with Veterans with spinal cord injury and disorders (SCI/D). To examine self-efficacy in Veterans with SCI/D reporting high versus low perceptions of physical function. Department of Veterans Affairs (VA) Spinal Cord Injury System of Care—nation-wide, 24 Spinal Cord Injury (SCI) Centers. The survey provided patient-reported data on demographic and injury characteristics, basic mobility and fine motor function, and perceived self-efficacy. Bivariate comparisons were conducted to compare perceptions of self-efficacy between Veterans with SCI/D reporting perceptions of ‘high’ versus ‘low’ basic mobility and fine motor function. A multivariate logistic regression was conducted to identify factors independently associated with high physical function when controlling for covariates. Response rate (896/1452=61.7%). Multivariate analysis showed that age (odds ratio (OR)=0.98, 95% confidence interval (CI): 0.96–1.00, P=0.03), tetraplegia (OR=0.20, 95% CI: 0.13–0.32, P⩽0.0001), diabetes (OR=0.53, 95% CI: 0.31–0.91, P=0.02), depression (OR=0.62, 95% CI: 0.39–0.98, P=0.04) and pressure ulcers (OR=0.42, 95% CI: 0.25–0.72, P=0.001) were all independently associated with lower odds of high physical function. When controlling for covariates, persons with high self-efficacy were nearly two times more likely to have high physical function (OR=1.98, 95% CI: 1.22–3.22, P=0.01). Lower perceptions of basic mobility and fine motor function among individuals with SCI/D were correlated with lower self-efficacy, even when controlling for other covariates. The relationship between physical function and self-efficacy suggests that interventions focused on improving self-efficacy or physical function may also see improvements in the other. Further, studies exploring the impact of interventions on the relationship between self-efficacy and physical function are needed to understand the relationship between the two.

CONTEXT/OBJECTIVE: Although personal health record (PHR) portals are designed for patients, healthcare providers are a key influence in how patients use their features and realize benefits from them. A few studies have examined provider attitudes toward PHR portals, but none have focused on those who care for individuals with spinal cord injuries and disorders (SCI/D). We characterize SCI/D provider perspectives of PHR portals, including perceived advantages and disadvantages of PHR portal use in SCI/D care. DESIGN: Cross-sectional; semi-structured interviews. SETTING: Spinal Cord Injury (SCI) Centers in the Veterans Health Administration. PARTICIPANTS: Twenty-six SCI/D healthcare providers. INTERVENTIONS: None. OUTCOME MEASURES: Perceived advantages and disadvantages of PHR portals. RESULTS: The complex situations of individuals with SCI/D shaped provider perspectives of PHR portals and their potential role in practice. Perceived advantages of PHR portal use in SCI/D care included the ability to coordinate information and care, monitor and respond to outpatient requests, support patient self-management activities, and provide reliable health information to patients. Perceived disadvantages of PHR portal use in SCI/D care included concerns about the quality of patient-generated health data, other potential liabilities for providers and workload burden, and the ability of individuals with SCI/D to understand clinical information accessed through a portal. CONCLUSION: Our study highlights advantages and disadvantages that should be considered when promoting engagement of SCI/D healthcare providers in use of PHR portals, and portal features that may have the most utility in SCI/D care.

Background The Promoting Action on Research Implementation in Health Services (PARIHS) framework has been used by implementation researchers to assess factors impacting implementation and to use that information to identify optimal interventions and implementation strategies. In this paper, two studies are presented demonstrating the utility of PARIHS as a tool for retrospective and prospective evaluation of implementation in the health care setting. Study Design Descriptive case study. Methods A qualitative consensus process was used to evaluate provider perceptions of PARIHS constructs of evidence, context, and facilitation and their subelements which were scored on a continuum of low to high. Results The first example demonstrates retrospective use of PARIHS which provided insight into the factors contributing to variations in implementation across sites in an ongoing program. Evidence was strong (high), whereas context noted some challenges in culture and measurement (mixed), and the presence of dedicated program facilitators was positive but dual roles limited their ability to fully support implementation (mixed). The second example demonstrates prospective use of PARIHS for evaluation which gathered information about intervention sites for the purposes of selecting implementation strategies responsive to site needs. Evidence supporting the intervention was limited (low), context noted that limited awareness of the intervention was a challenge (low), and that a strong internal facilitator supported implementation (high). Linking Evidence to Action The descriptive case study presented here underscores the value of a theory-guided approach to implementation and highlights that PARIHS can help implementers understand factors impacting implementation, identify areas for future intervention, and inform selection of strategies to support or enhance implementation efforts.

BACKGROUND: Assessments of function in persons with spinal cord injury (SCI) often utilize pre-defined constructs and measures without consideration of patient context, including how patients define function and what matters to them. OBJECTIVES/HYPOTHESIS: We utilized photovoice to understand how individuals define function, facilitators and barriers to function, and adaptations to support functioning. METHODS: Veterans with SCI were provided with cameras and guidelines to take photographs of things that: (1) help with functioning, (2) are barriers to function, and (3) represent adaptations used to support functioning. Interviews to discuss photographs followed and were audio-recorded, transcribed, and analyzed using grounded-thematic coding. Nvivo 8 was used to store and organize data. RESULTS: Participants (n = 9) were male (89%), Caucasian (67%), had paraplegia (75%), averaged 64 years of age, and were injured, on average, for 22 years. Function was described in several ways: the concept of ‘normalcy,’ aspects of daily living, and ability to be independent. Facilitators included: helpful tools, physical therapy/therapists, transportation, and caregivers. Barriers included: wheelchair-related issues and interior/exterior barriers both in the community and in the hospital. Examples of adaptations included: traditional examples like ramps, and also creative examples like the use of rubber bands on a can to help with grip. CONCLUSION(S): Patient-perspectives elicited in-depth information that expanded the common definition of function by highlighting the concept of “normality,” facilitators and barriers to function, and adaptations to optimize function. These insights emphasize function within a patient-context, emphasizing a holistic definition of function that can be used to develop personalized, patient-driven care plans. Published by Elsevier Inc.

INTRODUCTION Family-centered care (FCC) involves partnering with patients and family/caregivers ("caregivers"), engaging them in decisions, and providing support. FCC may be measured across 3 dimensions: respect, collaboration, and support and needs likely vary by caregiver age. The objective was to examine and compare caregiver perceptions of FCC by age. METHOD We mailed surveys to family/caregivers of Veterans. We collected demographics and measured respect, collaboration, and support using the Family-Centered Care Survey (FCCS). We calculated mean values and conducted bivariate comparisons, dichotomized by caregiver age (≥60 vs.

Background Atopic dermatitis (AD) is a common skin disorder characterized by chronic inflammation, altered skin barrier function, and inflammatory cell skin infiltration that decreases health-related quality of life (HRQoL). The study objective was to understand the patient perspective of AD burden and determine suitable patient-reported outcome (PRO) measures. Methods This mixed methods study involved the collection of qualitative and quantitative information from adults (≥ 18 years old) and adolescents (12 – 17 years old) with clinician-confirmed AD regarding their experiences of AD symptoms and its impact on HRQoL. The first part of the study included three stages: in-person concept elicitation (CE) interviews, a 2-week daily electronic diary (eDiary) study, and in-person cognitive debriefing (CD) interviews. An Itch numeric rating scale (NRS) (v1.0) and a Skin Pain NRS (v1.0) evaluation during CD interviews required participants to think about their ‘worst’ itch and ‘worst’ skin pain in the past 24 h. Other PRO measures allowed for psychometric testing. The second part of the study involved telephone-depth interviews (TDIs) and qualitative feedback from participants who had not participated in the CD interviews. Qualitative data were thematically analyzed. Psychometric evaluation of NRS measures was performed using eDiary data. Results In the CE interviews, itch and/or itching and skin pain were the most prevalent symptoms consistently discussed by participants. Both NRS measures demonstrated strong psychometric reliability and were applicable across ages with suitable concurrent validity. During the CD interviews, some participants focused their answers on their ‘average’ itch/itching in the past 24 h, rather than their ‘worst’ itch. Some participants answered the Skin Pain NRS thinking about general pain or other types of pain, rather than skin pain specifically. Consequently, modifications to both measures addressed these issues and re-tested as paper-and-pen versions in subsequent TDIs. Itch NRS (v2.0) modifications helped participants focus on their worst itching. Most participants preferred Skin Pain NRS v2.0b, which included skin pain descriptors. Conclusions Itching and skin pain are the most important and relevant AD symptoms. The Itch NRS (v2.0) and Skin Pain NRS (v2.0b) appear to be appropriate endpoints for the assessment of itching and skin pain severity for clinical trials with adults and adolescents with AD.

Background: There is a need to engage persons with spinal cord injuries/disorders (SCI/D) in research methodologies beyond traditional approaches. This provides an opportunity for individuals to convey their perspectives in a variety of ways. Photovoice empowers people to share their perspectives through photographs and narrative; this is well-suited for individuals who are less comfortable speaking up when other methods are used, such as focus groups. Objective: To examine photovoice methodology in US Veterans with SCI/D to describe their experiences with and the utility of photovoice. We also provide a sample of content (qualitative data) to illustrate how individuals with SCI/D conceptualized function and factors important to them. Methods: Photovoice, a qualitative participatory research method, was used to collect photographs from Veterans with SCI/D, which was followed by personal narratives describing the meaning of their photos. Results: Participants (N = 9) were 64 years old, on average, and 75% had paraplegia. Participants discussed the challenges with taking photographs, but they enjoyed participating, appreciated inclusion, and hoped the information they provided would help others with disabilities. Conclusion: These findings suggest that despite challenges and ethical barriers, individuals with SCI/D are interested in, highly capable of, and should be given the opportunity to be included in studies like this that empower participants to share their views using novel ways of expression. These findings demonstrate the desirability, feasibility, and utility of using photovoice in individuals with SCI/D. This method may be used to understand factors impacting health and well-being and can be made available to individuals with SCI/D to minimize inequalities in research opportunities.

Objectives: The primary objective was to review the literature regarding methodologies to assess fracture risk, to prevent and treat osteoporosis and to manage osteoporotic fractures in SCI/D. Study Design: Scoping review. Settings/Participants: Human adult subjects with a SCI/D. Outcome measures: Strategies to identify persons with SCI/D at risk for osteoporotic fractures, nonpharmacological and pharmacological therapies for osteoporosis and management of appendicular fractures. Results: 226 articles were included in the scoping review. Risk of osteoporotic fractures in SCI is predicted by a combination of DXA-defined low BMD plus clinical and demographic characteristics. Screening for secondary causes of osteoporosis, in particular hyperparathyroidism, hyperthyroidism, vitamin D insufficiency and hypogonadism, should be considered. Current antiresorptive therapies for treatment of osteoporosis have limited efficacy. Use of surgery to treat fractures has increased and outcomes are good and comparable to conservative treatment in most cases. A common adverse event following fracture was delayed healing. Conclusions: Most of the research in this area is limited by small sample sizes, weak study designs, and significant variation in populations studied. Future research needs to address cohort definition and study design issues.

Objectives. Patient-Aligned Care Teams (PACTs) aim to reorganize primary care by putting the patient at the center of the care team that includes family and health care staff; embodying patient-centered care (PCC). Team members share information, and work together in a synergistic, supportive way to provide optimal care based on mutually negotiated goals to meet patient needs. Our objective was to evaluate the process, barriers, and facilitators to implementing PACT as part of a VA quality improvement effort.Study Design/Methods. Semi-structured interviews were conducted, transcribed verbatim and analyzed with constant comparative techniques using constructs from implementation and organizational frameworks. Respondent demographic and position-level data were also collected. Data were collected in 2013.Results. A purposive sample of 35 key leaders and staff involved in implementing and/or participating in PACT at VA facilities participated. Implementation barriers included: failure to gain staff buy-in for PACT early on and to alleviate existing concerns about time and resources, incongruent performance measurement, and lack of defined role/responsibilities. Implementation facilitators included: training and engaging staff in PCC delivery and support for team-building.Conclusions. Team-based approaches to care have strong literature support; less is known about implementation. This study provides insight into the implementation of team-based care. Implementation of a team-based care model should include staff preparation and support (awareness, education, and encouragement) in advance. Once implemented, continued attention to team-building efforts and staff engagement are needed for sustainability. Healthcare organizations must understand and address multiple organizational factors to successfully implement team-based care that leads to systemic and sustainable PCC delivery.

We report on healthcare worker use of a safe zone (outside a 3-foot perimeter around the patient’s bed) and personal protective equipment in 2 inpatient spinal cord injury/disorder units. Workers remained within the safe zone during 22% of observations but were less compliant with personal protective equipment inside the zone.Infect Control Hosp Epidemiol 2016;37:714–716

Participation is a significant rehabilitation outcome for individuals with spinal cord injury and/or disorder (SCI/D), yet few qualitative studies have described the social aspect of disability and community participation. We used the photovoice methodology to explore perceptions and experiences related to participation among Veterans with SCI/D. We recruited a convenience sample of individuals with SCI/D at the Hines Veterans Affairs (VA) SCI/D Unit. Participants were asked to take photographs exemplifying their experiences and activities regarding participation. Within four weeks, participants returned their photographs and completed semi-structured interviews to discuss their photographs. Interview transcripts were analyzed using an inductive coding approach to identify emerging themes. Of the 18 Veterans with SCI/D who completed the initial orientation session, 9 (50%) completed the photography phase and follow-up interviews. A majority of participants were White (67%) and the mean age was 64 years. The mean duration of injury was 21.8 years, and 75% of participants were paraplegic. Most participants (78%) were community-dwelling. All participants discussed participation as a highly relevant issue in their lives. A majority of participants (67%) described sports as an example of participation. Over half (56%) emphasized the positive effects of participation (i.e., feelings of enjoyment / accomplishment) in sports as well as engaging in faith-based activities, being outdoors, and managing business- or household-related responsibilities. Barriers to participation were mobility impairments, lack of transportation and cost. Findings from this study can be used to address environmental changes or other accommodations that influence participation, both inside and outside the health care setting. Keywords: Spinal Cord Injury, Community Participation, Photovoice, Veterans Approximately 276,000 individuals are living with a spinal cord injury and/or disorder (SCI/D) and about 12,500 new SCI/D cases are reported each year in the United States (US; DeVivo, 2012; National Spinal Cord Injury Statistical Center, 2015). The presence of SCI/D can result in a range of physical, psychological and social challenges (Gerhart, Bergstrom, Charlifue, Menter, & Whiteneck, 1993; Kennedy, Lude, & Taylor, 2006; Silver, Ljungberg, Libin, & Groah, 2012). An integral component of overall well-being among individuals with SCI/D is community participation (Barclay, McDonald, & Lentin, 2015; World Health Organization, 2001), which includes engagement in occupational, social and leisure activities, as well as active involvement in an individual's environment (Magasi, Hammel, Heinemann, Whiteneck, & Bogner, 2009; Ripat & Woodgate, 2012; Van de Velde, Bracke, Van Hove, Josephsson, & Vanderstraeten, 2010). The importance of community participation among individuals with SCI/D is highlighted by recent national priorities delineated by Healthy People 2020 to reduce the proportion of Americans with disabilities that experience barriers to participation in work, school, and other community settings (US Department of Health and Human Services, 2010). Although participation remains a significant rehabilitation and community integration outcome for individuals with SCI/D, few studies have described the social aspect of disability and community participation. Qualitative studies that evaluate experiences and perceptions around participation in the SCI/D community have been particularly limited. Data that account for the perspectives of individuals with SCI/D are needed to enhance interventions that aim to improve community participation and individual outcomes in this population (Kehn & Kroll, 2009; Simpson, Eng, Hsieh, Wolfe, & Spinal Cord Injury Rehabilitation Evidence Research Team, 2012). Furthermore, characterizing participation, in depth, is especially important given evidence that participation is driven by an individual's unique needs, lived experiences, and environment (Ripat & Woodgate, 2012; Whiteneck, 2006). …

OBJECTIVE To examine preferences for relational continuity and rapid accessibility for telephone care. METHODS A mixed-methods sequential explanatory design was utilized. Structured telephone interviews were conducted with 448 Veterans receiving primary care from Veterans Affairs facilities, who rated the importance of relational continuity and rapid accessibility. Seventeen focus groups were conducted with 123 Veterans to examine preferences for continuity versus accessibility and factors affecting these preferences. RESULTS Higher proportions of interview patients rated talking with a nurse from their own primary care team (69%) and talking with a nurse with whom they have previous primary care contact (60%) as very important, compared with talking to any nurse as soon as possible (53%) and receiving advice immediately (50%). Focus group participants preferred a familiar provider within 24 hours over immediate contact with an unfamiliar provider, particularly for routine needs. Rapid accessibility was more frequently preferred for urgent questions/concerns. Preference for relational continuity was mitigated by patient age, and access to electronic medical records in larger, but not smaller, facilities. CONCLUSIONS Health care systems supplementing in-person care with telephone care need to ensure that this care aligns with patient preferences and provide opportunities for both relational continuity and rapid accessibility where possible.

The objective of this analysis was to understand the relationship between knowledge and attitudes regarding methicillin-resistant Staphylococcus aureus and hand hygiene behavior based on a baseline survey administered to Veterans with spinal cord injuries and disorders. Higher knowledge was associated with higher attitude scores ( r = 0.35, P = .003), but knowledge and attitudes were not associated with behavior. Also, those with quadriplegia had higher knowledge scores ( P = .03). Knowledge and attitudes, although related, do not appear to fully explain patients' hand hygiene behavior.

A1 Introduction to the 8th Annual Conference on the Science of Dissemination and Implementation: Optimizing Personal and Population Health David Chambers1, Lisa Simpson2 1Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, 20850, USA; 2AcademyHealth, Washington, DC, 20036, USA For the second year in a row, we are pleased to be able to share the proceedings of the Annual Conference on the Science of Dissemination and Implementation in Health, a large meeting reflecting the expanding and evolving research field that seeks to optimize the use of evidence, interventions, and tools from health research within the myriad of settings where people receive health care, make health-related decisions, and increase knowledge of influences on the health of the population. We once again benefitted from a strong partnership, co-led by AcademyHealth and the National Institutes of Health (NIH), with co-sponsorship from the Agency for Healthcare Research and Quality (AHRQ), the Patient Centered Outcomes Research Institute (PCORI), the Robert Wood Johnson Foundation (RWJF), the US Department of Veterans Affairs (VA), and the WT Grant Foundation. In addition, we benefitted from the collaboration of staff from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). NIH and AcademyHealth again co-led the program planning committee, which focused on the development of the plenary sessions, and convened a scientific advisory panel to suggest speakers and advise on the overall conference development. The planning committee identified four key areas around which to focus the plenary panels and keynote address. Dr. America Bracho, M.D., M.P.H., Executive Director of Latino Health Access in Orange County, California, spoke about the opportunities for implementation science to inform efforts to improve community health and engage underserved populations. The three plenary panels each focused on a significant future direction for dissemination and implementation (D & I) research: the interface between D&I science and population health, emerging opportunities for global implementation science, and the challenges around implementation of precision medicine. The plenary sessions were complemented by facilitated lunchtime discussions on the same three topics, which offered participants an opportunity to identify key research questions for each and brainstorm next steps. Synopses of the lunchtime discussions are included in this supplement. Given the overwhelming success of the 2014 conference and the large number of abstracts received in 2014 (660), the program planning committee identified eight program tracks for abstract submitters to respond to, and through which the concurrent sessions of the conference would be organized. These tracks—Behavioral Health, Big Data and Technology for Dissemination and Implementation Research, Clinical Care Settings, Global Dissemination and Implementation, Promoting Health Equity and Eliminating Disparities, Health Policy Dissemination and Implementation, Prevention and Public Health, and Models, Measures and Methods— were designed to enable conference participants to follow a consistent theme across the multiple sessions of the conference and form the structure of this supplement. The call for abstracts, including individual paper presentations, individual posters and panel presentations, resulted in 515 submissions, spread across the eight thematic tracks. Over one hundred reviewers devoted their time to ensuring a comprehensive and expert review, and reviews were conducted within each track and coordinated by the track leads. For the final program, 64 oral presentations, 12 panels, and 263 posters were presented over the two-day meeting. Slides for the oral presentations and panels (with the agreement of the authors) were posted on the conference website (http://diconference.academyhealth.org/archives/2015archives) and all abstracts were included on the conference webapp (https://academyhealth.confex.com/academyhealth/2015di/meetingapp.cgi). This supplement has compiled the abstracts for presented papers, panel sessions, and lunchtime discussions from the 8th Annual Meeting on the Science of Dissemination and Implementation in Health: Optimizing Personal and Population Health. We are pleased to have the abstracts from the conference together in one volume once again, and look forward to the 9th Annual meeting, scheduled for December in Washington, D.C.

Objective: Patients with comorbid chronic conditions may prioritize some conditions over others; however, our understanding of factors influencing those prioritizations is limited. In this study, we sought to identify and elaborate a range of factors that influence how and why patients with comorbid chronic conditions prioritize their conditions. Methods: We conducted semi-structured, one-on-one interviews with 33 patients with comorbidities recruited from a single Veterans Health Administration Medical Center. Findings: The diverse factors influencing condition prioritization reflected three overarching themes: (1) the perceived role of a condition in the body, (2) self-management tasks, and (3) pain. In addition to these themes, participants described the rankings that they believed their healthcare providers would assign to their conditions as an influencing factor, although few reported having shared their priorities or explicitly talking with providers about the importance of their conditions. Conclusion: Studies that advance understanding of how and why patients prioritize their various conditions are essential to providing care that is patient-centered, reflecting what matters most to the individual while improving their health. This analysis informs guideline development efforts for the care of patients with comorbid chronic conditions as well as the creation of tools to promote patient–provider communication regarding the importance placed on different conditions.

The Promoting Action on Research Implementation in Health Services (PARIHS) framework has been used by implementation researchers to assess factors impacting implementation and to use that information to identify optimal interventions and implementation strategies. In this paper, two studies are presented demonstrating the utility of PARIHS as a tool for retrospective and prospective evaluation of implementation in the health care setting.Descriptive case study.A qualitative consensus process was used to evaluate provider perceptions of PARIHS constructs of evidence, context, and facilitation and their subelements which were scored on a continuum of low to high.The first example demonstrates retrospective use of PARIHS which provided insight into the factors contributing to variations in implementation across sites in an ongoing program. Evidence was strong (high), whereas context noted some challenges in culture and measurement (mixed), and the presence of dedicated program facilitators was positive but dual roles limited their ability to fully support implementation (mixed). The second example demonstrates prospective use of PARIHS for evaluation which gathered information about intervention sites for the purposes of selecting implementation strategies responsive to site needs. Evidence supporting the intervention was limited (low), context noted that limited awareness of the intervention was a challenge (low), and that a strong internal facilitator supported implementation (high).The descriptive case study presented here underscores the value of a theory-guided approach to implementation and highlights that PARIHS can help implementers understand factors impacting implementation, identify areas for future intervention, and inform selection of strategies to support or enhance implementation efforts.

Objective: To measure patients’ perceptions of the environment of care (EOC), with a focus on the physical environment, in which healthcare is delivered. Background: The EOC may impact patient experiences, care perceptions, and health outcomes. EOC may be improved through redesign of existing physical structures or spaces or by adding nurturing amenities. Methods: Demographics, health status, hospital use, and data on the environment (physical, comfort, orientation, and privacy) were collected via a mailed cross-sectional survey sent to patients seen at four hospital Centers of Innovation (COIs; that implemented many modifications to the healthcare environment to address physical, comfort, orientation, and privacy factors) and four matched controls, supplemented with checklist and VA administrative data. A modified Perceived Hospital Environment Quality Indicators instrument was used to measure patients’ EOC perceptions. Results: Respondents (3,321/5,117; 65% response) rated, [mean ( SD)], exterior space highest, 3.09 (0.73), followed by interior space, 2.96 (0.74), and privacy, 2.44 (1.01). COIs had significantly higher ratings than controls on interior space (2.99 vs. 2.96, p = .02) and privacy (2.48 vs. 2.38, p = .005) but no differences for exterior space. Subscales with significantly higher ratings in COIs (vs. controls) in interior space were “spatial–physical comfort” and “orientation,” for example, clean, good signage, spacious rooms, and for privacy included “not too crowded” and “able to talk without being overheard.” Checklist findings confirmed the presence of EOC innovations rated highly by patients. Conclusions: Patients identified cleanliness, good signs/information points, adequate seating, nonovercrowding, and privacy for conversations as important. Hospital design modifications, with particular attention to the physical environment, can improve patient EOC perceptions.

Retrospective observational study of bacterial susceptibilities in Veterans with SCI/D as compared to a general patient population. The purpose of this project was to evaluate the prevalence and susceptibility of bacteria isolated from spinal cord injury and disorder (SCI/D) patients as compared with a general patient population and determine whether a SCI/D-specific antibiogram, a report of bacterial susceptibilities used to guide empiric antibiotic selection, would be a useful stewardship tool. Veterans Affairs Medical Center located in Cook county, IL, USA. Microbiology reports from 1 October 2012 to 30 September 2013 were compiled into a SCI/D-specific antibiogram and compared to a non-SCI/D antibiogram. Persons with positive cultures and SCI/D were younger and had a higher Charlson Index as compared to non-SCI/D patients (P

Methods Articles in the Cochrane Database of Systematic Reviews, Effective Practice and Organization of Care (EPOC) that included at least one of the 47 Cochrane Review implementation strategies were retrieved yielding 1158 articles in 337 journals. We selected publications from the 3 journals with the largest number of articles: British Medical Journal (BMJ), Journal of the American Medical Association (JAMA), and Medical Care. We developed an “Implementation Strategy Fidelity Score” based on definitions adapted from Dusenbury (2003) [1]. Adherence (documenting implementation strategies and extent to which they took place), dose (proportion of people receiving each strategy) and participant responsiveness (extent to which individuals were involved in the development or evaluation of strategies or their receptivity to them) were scored on a 3-point scale: 0=no detail, 1=some detail, and 2=great detail.

This practice forum reports experiences with the development of a unit-specific antibiogram and planning for its implementation. Involvement of internal and external facilitators was a key strategy for addressing issues, including data limitations, coordination, and planning. These activities were incorporated and reported as part of the facility's broader antimicrobial stewardship program, and represent the first step in a set of planned projects to evaluate the impact of antibiograms on provider behavior and patient outcomes.

Background Access to health information is crucial to persons living with a spinal cord injury or disorder (SCI/D). Although previous research has provided insights on computer and Internet use among persons with SCI/D, as well as how and where persons with SCI/D gather health information, few studies have focused on U.S. veterans with SCI/D. Objective To characterize health information seeking among veterans with SCI/D and to examine the association between technology use and the characteristics of veterans with SCI/D. Design Cross-sectional. Setting Veterans Health Administration (VHA). Participants Sample of 290 veterans with SCI/D who utilize services at 2 VHA SCI/D Centers. Methods Postal mail survey. Main Outcome Measurements Extent of computer, Internet, and text messaging use, information source use, and e-Health literacy rates. Results The survey response rate was 38%. The majority of respondents were male (97.2%), younger than 65 years (71.0%), and white (71.7%). Of the respondents, 64.8% indicated that they use a computer, 62.9% reported use of the Internet, and 26.2% reported use of text messaging. The mean overall e-Health Literacy Scale score was 27.3 (standard deviation=7.2). Similar to findings reported in studies focused outside the veteran population, the most frequent source that veterans turned to for information about SCI/D was a health professional (85.1%); this was also the most frequent source that veterans indicated they would turn to first to get information about SCI/D (75.9%). Other frequently reported sources of information included other persons with SCI/D (41.0%), Internet resources (31.0%), and family and friends (27.9%). Conclusions Fairly high levels of computer and Internet use exist among veterans with SCI/D. Veterans with SCI/D also have a strong preference for people—particularly health professionals, and to a lesser extent peers and family and friends—as sources of information about SCI/D. These findings highlight the importance of combining technology and human interaction to meet the information needs of this population.

Health care worker (HCW) vaccination rates have been low for many years (approximately 50%). Our goal was to implement an influenza declination form program (DFP) to assess feasibility, participation, HCW vaccination, and costs.This was a prospective interventional pilot study using mixed methods to evaluate the DFP implementation processes and outcomes. We conducted a formative evaluation and interviews; data were transcribed and coded into themes. Secondary outcomes included self-reported HCW influenza vaccine uptake (pre-/postsurvey) and program costs; data were evaluated using descriptive and bivariate analyses.The DFP was compatible with ongoing strategies and unit culture. Barriers included multiple hospital shifts and competing demands. Facilitators included complementary ongoing strategies and leadership engagement. HCW vaccination rates were higher post- versus preimplementation (77.4% vs 53.5%, P =.01). To implement the DFP at site 1, using a mobile flu cart, 100% of declination forms were completed in 42.5 staff hours over2 months. At site 2, using a vaccination table on all staff meeting days, 49% of forms were completed in 26.5 staff hours over 4.5 months. Average cost of staff time was $2,093 per site.DFP implementation required limited resources and resulted in increased HCW influenza vaccine rates; this may have positive clinical implications for influenza infection control/prevention.

Background The goal of this study was to assess current practices for training of spinal cord injury and disorder (SCI/D) health care workers and education of veterans with SCI/D in Department of Veterans Affairs (VA) spinal cord injury (SCI) centers on methicillin-resistant Staphylococcus aureus (MRSA) prevention. Methods Mixed methods. A Web-based survey was distributed to 673 VA SCI/D providers across 24 SCI centers; 21 acute care and 1 long-term care facility participated. There were 295 that responded, 228 had complete data and were included in this analysis. Semistructured interviews were conducted with 30 SCI/D providers across 9 SCI centers. Results Nurses, physicians, and therapists represent most respondents (92.1%, n = 210); over half (56.6%, n = 129) were nurses. Of providers, 75.9% (n = 173) reported receiving excellent or good training on how to educate patients about MRSA. However, nurses were more likely to report having excellent or good training for how to educate patients about MRSA (P = .005). Despite this, only 63.6% (n = 82) of nurses perceived the education they provide patients on how MRSA is transmitted as excellent or good. Conclusion Despite health care workers reporting receiving excellent or good training on MRSA-related topics, this did not translate to excellent or good education for patients, suggesting that health care workers need additional training for educating patients. Population-specific MRSA prevention educational materials may also assist providers in educating patients about MRSA prevention for individuals with SCI/D.

To assess the feasibility and effect of a nurse-administered patient educational intervention about Methicillin-resistant Staphylococcus aureus (MRSA) prevention on knowledge and behavior of Veterans with spinal cord injuries and disorders (SCI/D).Blinded, block-randomized controlled pilot trial.Two Department of Veterans Affairs (VA) SCI Centers.Veterans were recruited March-September 2010 through referral by a healthcare provider from inpatient, outpatient, and residential care settings.Thirty participants were randomized to the nurse-administered intervention and 31 to the usual care group. The intervention included a brochure and tools to assist nurses in conducting the education.Pre- and post-intervention measurement of knowledge and behaviors related to MRSA and prevention strategies and feasibility measures related to implementation.Participants were primarily male (95.1%), white (63.9%), with tetraplegia (63.9%) and mean age and duration of injury of 64.3 and 20.5 years, respectively. The intervention groups mean knowledge score significantly increased between pre- and post-test (mean change score = 1.70, 95% confidence interval, CI 0.25-3.15) while the usual care groups score did not significantly change (mean change score = 1.45, 95% CI -0.08-2.98). However, the mean knowledge change between intervention and usual care groups was not significantly different (P = 0.81). Overall behavior scores did not significantly differ between treatment groups; however, the intervention group was more likely to report intentions to clean hands (90.0% vs. 64.5%, P = 0.03) and asking providers about MRSA status (46.7% vs. 16.1%, P = 0.01). Nurse educators reported that the quality of the intervention was high and could be implemented in clinical care.A targeted educational strategy is feasible to implement in SCI/D clinical practices and may improve some participants' knowledge about MRSA and increase intentions to improve hand hygiene and engagement with providers about their MRSA status.

Background Primary care is the foundation of the Department of Veterans Affairs (VA) health care, but transformation efforts are necessary to meet the needs of Veterans and provide patient-centered care (PCC). Problem The need to transform the VA from a problem/disease-based provider-driven system to a patient-centered, patient-driven health care system. Goals Our project objective was to describe the implementation of the Patient-Aligned Care Team (PACT) model in the current Department of Veterans Affairs (VA) health care environment and to identify barriers and facilitators to implementing a new model of care that could apply more broadly to the implementation of large-scale changes in other large integrated health care systems. Strategy We sought to learn through in-depth interviews with leaders and key informants at several stages of the PACT process, including planning, implementing, modifying where needed, and maintenance. Results The PACT model offers PCC that is managed with high quality, safety, and effectiveness; provides optimal access; and integrates the Veterans’ voice to respect their preferences, needs, and values toward achieving optimal health and well-being. Implications This transformation in VA provides insight into the barriers and facilitators to implementing large-scale change in an integrated health care system. Implementation of a new model of care across a large integrated health care system requires continuous and highly visible engagement from leadership and staff, distribution of resources across initiatives, and alignment of program goals and performance measures, these lessons.

Background To prevent methicillin-resistant Staphylococcus aureus (MRSA) in Spinal Cord Injury and Disorder (SCI/D) Centers, the “Guidelines for Implementation of MRSA Prevention Initiative in the Spinal Cord Injury Centers” were released in July 2008 in the Veterans Affairs (VA) Health Care System. The purpose of this study was to use the Promoting Action on Research Implementation in Health Systems (PARiHS) framework to evaluate the experiences of implementation of SCI/D MRSA prevention guidelines in VA SCI/D Centers approximately 2–3 years after the guidelines were released. Methods Mixed methods were used across two phases in this study. The first phase included an anonymous, web-based cross-sectional survey administered to providers at all 24 VA SCI/D Centers. The second phase included semi-structured telephone interviews with providers at 9 SCI/D Centers. The PARiHS framework was used as the foundation of both the survey questions and semi-structured interview guide. Results The survey was completed by 295 SCI/D providers (43.8 % response rate) from 22 of the 24 SCI/D Centers (91.7 % participation rate). Respondents included nurses (57.3 %), therapists (24.4 %), physicians (11.1 %), physician assistants (3.4 %), and other health care professionals (3.8 %). Approximately 36 % of the SCI/D providers surveyed had not seen, did not remember seeing, or had never heard of the MRSA SCI/D guidelines, whereas 42.3 % of providers reported that the MRSA SCI/D guidelines were fully implemented in their SCI/D Center. Data revealed numerous barriers and facilitators to guideline implementation. Facilitators included enhanced leadership support and provider education, focused guideline dissemination to reach SCI/D providers, and strong perceived evidence supporting the guidelines. Barriers included lack of awareness of the guidelines among physical therapists and physician assistants and challenges in cohorting/isolating MRSA-positive patients and following contact precautions. Conclusions Successful implementation of MRSA infection prevention guidelines in SCI/D settings requires (1) guideline dissemination that reaches the full range of SCI/D providers working in inpatient, outpatient, and other care settings, (2) provider education that is frequent and systematic, (3) strong leadership support, and (4) that barriers unique to the recommendations are addressed. These findings may be used to inform selection of implementation strategies and optimize infection prevention beyond MRSA as well as in other specialty care populations. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0318-x) contains supplementary material, which is available to authorized users.

Background Implementation fidelity is critical to the internal and external validity of implementation research. Much of what is written about implementation fidelity addresses fidelity of evidence-informed interventions rather than fidelity of implementation strategies. The documentation and reporting of fidelity to implementation strategies requires attention. Therefore, in this scoping review, we identify the extent and quality of documentation and reporting of fidelity of implementation strategies that were used to implement evidence-informed interventions. Methods A six-stage methodological framework for scoping studies guided our work. Studies were identified from the outputs of the Effective Practice and Organization of Care (EPOC) review group within the Cochrane Database of Systematic Reviews. EPOC’s primary focus, implementation strategies influencing provider behavior change, optimized our ability to identify articles for inclusion. We organized the retrieved articles from the systematic reviews by journal and selected the three journals with the largest number of retrieved articles. Using a data extraction tool, we organized retrieved article data from these three journals. In addition, we summarized implementation strategies using the EPOC categories. Data extraction pertaining to the quality of reporting the fidelity of implementation strategies was facilitated with an “Implementation Strategy Fidelity Checklist” based on definitions adapted from Dusenbury et al. We conducted inter-rater reliability checks for all of the independently scored articles. Using linear regression, we assessed the fidelity scores in relation to the publication year. Results Seventy-two implementation articles were included in the final analysis. Researchers reported neither fidelity definitions nor conceptual frameworks for fidelity in any articles. The most frequently employed implementation strategies included distribution of education materials (n = 35), audit and feedback (n = 32), and educational meetings (n = 25). Fidelity of implementation strategies was documented in 51 (71 %) articles. Inter-rater reliability coefficients of the independent reviews for each component of fidelity were as follows: adherence = 0.85, dose = 0.89, and participant responsiveness = 0.96. The mean fidelity score was 2.6 (SD = 2.25). We noted a statistically significant decline in fidelity scores over time. Conclusions In addition to identifying the under-reporting of fidelity of implementation strategies in the health literature, we developed and tested a simple checklist to assess the reporting of fidelity of implementation strategies. More research is indicated to assess the definitions and scoring schema of this checklist. Careful reporting of details about fidelity of implementation strategies will make an important contribution to implementation science. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0320-3) contains supplementary material, which is available to authorized users.