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With Minneapolis, Minnesota, partners, we developed a community-based participatory intervention using a mobile health application to provide actionable data to communities. More than 550 participants completed the survey. Key messages included strengths in our homes, neighborhoods, and faith communities. Key challenges were related to substance use and sleeping. We jointly conducted virtual community meetings such as webinars, Facebook Live shows, and online newsletters to begin to shift the community narrative from deficits to whole-person health, including strengths. (Am J Public Health. 2022;112(S3):S275–S278. https://doi.org/10.2105/AJPH.2022.306852 )

Performance improvement on clinical quality outcomes typically requires significant effort by personnel in health care organizations. Understanding the cost of quality improvement is important given diffusion of value-based contracting. This study investigates the organizational costs and benefits associated with planning and implementing the Ask about Aspirin intervention to increase use of low-dose aspirin in clinically recommended patient populations. Data from 4 health systems in Minnesota were used to estimate personnel effort and labor resource costs as well as corresponding benefits, measured as the change in aspirin use among eligible candidates during the study period. Overall personnel effort across the 4 systems was approximately 3900 hours with corresponding resource costs estimated to be $214,385. Aspirin use increased 4.7% overall, corresponding to roughly 1530 new users in the aspirin candidate population. Significant variation was observed by system in total hours reported, distribution of effort by activity type, and in benefits realized from the intervention.

Given the complex health and social needs of older adults, the rapid growth of the aging population, and the increasing use of information technology in healthcare, there is a critical need for informatics solutions that advance gerontological nursing care and knowledge discovery. This article illustrates the value of standardized data for healthcare quality improvement throughout the life cycle of data capture and reuse. One such informatics solution is the MyStrengths+MyHealth app, which incorporates a whole-person perspective through the Simplified Omaha System Terms assessment, including the social and behavioral determinants of health, as well as resilience. The data describe whole-person health of older adults from MyStrengths+MyHealth for use in clinical encounters and as raw data for research. There is potential to use such standardized data to improve gerontological nursing care at the bedside and for population health management and research.

Introduction Daily aspirin use for primary cardiovascular disease prevention is common among adults. Numerous clinical trials observe reduced cardiovascular disease with regular low-dose aspirin. The U.S. Preventive Services Task Force in 2016 published guidelines for aspirin use, but controversy exists about the side effects, and overuse or underuse may be common despite the guidelines. Using the Task Force recommendations, this paper describes the prevalence of appropriate aspirin use and physician advice in a population sample. Methods A random sample of men and women (aged 50-69 years) living in the Upper Midwest in 2017-2018 were surveyed, collecting demographic data, health history, and aspirin use. Appropriate primary prevention with aspirin was defined as having ≥10% cardiovascular disease risk (hypertension, hyperlipidemia, diabetes, smoking) with daily or every other day aspirin use. Those with prevalent cardiovascular disease were labeled as secondary prevention. Results A total of 1,352 adults were surveyed (697 women, 655 men). The criteria for secondary prevention were fulfilled in 188 participants, and these were eliminated from the analysis. In the remaining group, aspirin was indicated in 32.9% (383 of 1,164). Among those, 46.0% (176 of 383) were appropriate users, and 54.0% (207 of 383) were nonusers despite indications. Overuse, where aspirin is not indicated, was common at 26.9% (210 of 781). Discussion with a physician, although reported in 29% of subjects, was associated with some improvement in the appropriate use but also with overuse and underuse. Conclusions Aspirin use for primary cardiovascular disease prevention is common. However, many adults are medicating without indication (overuse) or are not using aspirin despite guidelines (underuse).

Purpose To explore resilience in the context of whole‐person health and the social determinants of health at the individual and community levels using large, standardized nursing datasets. Design A retrospective, observational, correlational study of existing deidentified Health Insurance Portability and Accountability Act (HIPAA)‐compliant data using the Omaha System and its equivalent, Simplified Omaha System Terms. Methods We used three samples to explore for patterns of resilience: pre‐COVID‐19 community‐generated data (N = 383), pre‐COVID‐19 clinical documentation data (N = 50,509), and during‐COVID‐19 community‐generated data (N = 102). Community participants used the My Strengths + My Health (MSMH) app to generate the two community datasets. The clinical data were obtained from the Omaha System Data Collaborative. We operationalized resilience as Omaha System Status scores of 4 (minimal signs or symptoms) or 5 (no signs or symptoms) as a discrete strengths measure for each of 42 Omaha System problem concepts. We used visualization techniques and standard descriptive and inferential statistics for analysis. Findings It was feasible to examine resilience, operationalized as strengths by problem concept, within existing Omaha System or Simplified Omaha System Terms (MSMH) data. We identified several patterns indicating strengths and resilience that were consistent with literature related to community connectedness for community participants, and sleep for individuals in the clinical data. Conclusions When used consistently, the Omaha System within MSMH enabled robust data collection for a comprehensive, holistic assessment, resulting in better whole‐person data including strengths, and enabled us to discover a potentially useful approach for defining resilience in new ways using standardized nursing data. Clinical Relevance The notion that how we assess individuals and communities (i.e., the completeness of our assessments in relation to whole‐person health) determines what we can know about resilience is seemingly in opposition to the critical need to decrease documentation burden, despite the potential to shift from a problem deficit‐based assessment to one of strengths and resilience. However, a patient‐facing comprehensive assessment that includes resilience and the social determinants of health can provide a transformative, whole‐person platform for strengths‐based care and population management.

PURPOSE The aim of this study was to determine what strategies and factors are most important for high performance in the primary care of patients with diabetes. METHODS We performed a mixed-methods, cross-sectional, observational analysis of interviews and characteristics of primary care clinics in Minnesota and bordering areas. We compared strategies, facilitators, and barriers identified by 31 leaders of 17 clinics in high-, middle-, and low-performance quartiles on a standardized composite measure of diabetes outcomes for 416 of 586 primary care clinics. Semistructured interview data were combined with quantitative data regarding clinic performance and a survey of the presence of care management processes. RESULTS The interview analysis identified 10 themes providing unique insights into the factors and strategies characterizing the 3 performance groups. The main difference was the degree to which top-performing clinics used patient data to guide proactive and outreach methods to intensify treatment and monitor effect. Top clinics also appeared to view visit-based care management processes as necessary but insufficient, whereas all respondents regarded being part of a large system as mostly helpful. CONCLUSIONS Top-performing clinic approaches to diabetes care differ from lower-performing clinics primarily by emphasizing data-driven proactive outreach to patients to intensify treatment. Although confirmatory studies are needed, clinical leaders should consider the value of this paradigm shift in approach to care.

This report describes a Science Café innovation, using an interpreter to translate remarks and engage three underserved Minnesota communities. It also illustrates how translational research can emphasize community benefit by combining longer-term knowledge production goals with shorter-term goals such as developing materials that are responsive to community health literacy needs.

Low-dose aspirin is used for primary prevention of cardiovascular disease in approximately one-third of the US adult population. Overuse and underuse are common and not concordant with guidelines.To test a community and clinic education intervention to improve guideline-based aspirin use for the primary prevention of cardiovascular disease.The Ask About Aspirin project was a nonrandomized controlled trial conducted from, July 1, 2015, to March 31, 2020, using professional education, traditional media, and digital media to improve guideline-based aspirin use. The adult population (aged 45-79 years for men and 55-79 years for women) and primary care clinics in Minnesota were the education targets. The 4 adjacent states were controls.The statewide campaign distributed billboards, newspaper articles and other print material, and radio announcements. An Ask About Aspirin website was heavily promoted. Primary care clinics identified appropriate aspirin candidates, and clinicians received continuing education about aspirin.Guideline-based aspirin use by the target population.Cross-sectional random telephone surveys of 8342 men aged 45 to 79 years and women aged 55 to 79 years were conducted at baseline, 2 years, and 4 years after the intervention. Participation was similar between men and women (baseline: 973 [49%] vs 1001 [51%]; year 4: 912 [50%] vs 930 [50%]). Age during the study also was similar (baseline: 64.7 [IQR, 64.4-65.1] years; year 4: 66.2 [IQR, 65.8-66.5] years). A validated questionnaire evaluated aspirin use. The Ask About Aspirin website had more than 1 million visits; 124 primary care clinics with more than 1000 participating clinicians were part of the education program. Small, nonsignificant increases in discussions with clinicians regarding aspirin resulted (baseline: 341 of 1001 [34%]; year 4: 339 of 930 [36%]; P = .27). Overall aspirin use decreased after the release of new US Preventive Services Task Force guidelines in 2016 and 3 aspirin randomized clinical trials in 2018 suggested reduced aspirin use (baseline: 816 of 1974 [41%]; year 4: 629 of 1842 [34%]; P .001). Decreases were also noted from year 2 to year 4 in appropriate use (year 2: 597 of 1208 [49%]; year 4: 478 of 1191 [40%]; P .001) and overuse (year 2: 170 of 602 [28%]; year 4: 151 of 651 [23%]; P = .04). There were no significant differences between Minnesota and the control states.In this nonrandomized controlled trial, a multiyear statewide campaign was not associated with increased appropriate aspirin use for cardiovascular disease prevention. Contextual factors during the project, including guideline changes and media controversy following the new trials, undermined study goals. These findings suggest that although education programs using social media for cardiovascular disease prevention can result in millions of hits, the use of this strategy to encourage behavior change is problematic, even with supportive clinical sites.ClinicalTrials.gov Identifier: NCT02607917.

Cardiovascular disease (CVD) persists as the leading cause of death and disability in many Americans including Hispanics. Primary prevention for CVD may be achieved through regular aspirin use in high risk individuals. This study examined regular aspirin use and specific attitudes and social norms toward CVD and aspirin use within an urban Hispanic population in Minnesota. A sample of primary prevention Hispanics aged 45–79 years were surveyed about CVD history and risk factors, aspirin use, demographic characteristics, and health beliefs and social norms in relation to CVD and aspirin. Relative risk estimation using Poisson regression with robust error variance was used to examine associations with aspirin use. In this sample of 152 Hispanics (55% women), the mean age was 53 years, 70% had a regular healthcare provider, and 22% used aspirin. Aspirin discussions with a regular healthcare provider were strongly associated with aspirin use (adjusted risk ratio 3.02, 95% CI 1.20–7.60). There was a positive association between health beliefs and social norms that affirm preventive behaviors and aspirin use (adjusted linear risk ratio 1.23, 95% CI 1.04–1.45) while uncertainty about the role of aspirin for individual use and in the community was negatively associated with aspirin use (adjusted linear risk ratio 0.85, 95% CI 0.70–1.03). This growing population may benefit from health education about CVD risk and the role of aspirin in prevention.

PURPOSE: The purpose of this study was to assess whether primary care practices certified as medical homes differ in having the practice systems required for that designation and in attaining favorable outcomes for their patients with diabetes, and whether those systems are associated with better diabetes outcomes. METHODS: We undertook a cross-sectional observational study, Understanding Infrastructure Transformation Effects on Diabetes (UNITED), of 586 Minnesota adult primary care practices, comparing those that were certified vs uncertified as medical homes in 2017, with analyses supplemented by previously published studies of these practices. We collected survey information about the presence of medical home practice systems for diabetes care and obtained 6 standardized measures of diabetes care collected yearly from all Minnesota practices. RESULTS: Of 416 practices completing questionnaires (71% of all practices, 92% of participating practices), 394 had data on diabetes care measures. Uncertified practices (39%) were more likely than certified practices to be rural, but their patient populations were similar. Certified practices had more medical home practice systems (79.2% vs 74.9%, P =.01) and were more likely to meet a composite measure of optimal diabetes care (46.8% vs 43.2%, P

Efforts to move community engagement in research from marginalized to mainstream include the NIH requiring community engagement programs in all Clinical and Translational Science Awards (CTSAs). However, the COVID-19 pandemic has exposed how little these efforts have changed the dominant culture of clinical research. When faced with the urgent need to generate knowledge about prevention and treatment of the novel coronavirus, researchers largely neglected to involve community stakeholders early in the research process. This failure cannot be divorced from the broader context of systemic racism in the US that has contributed to Black, Indigenous, and People of Color (BIPOC) communities bearing a disproportionate toll from COVID-19, being underrepresented in COVID-19 clinical trials, and expressing greater hesitancy about COVID-19 vaccination. We call on research funders and research institutions to take decisive action to make community engagement obligatory, not optional, in all clinical and translational research and to center BIPOC communities in this process. Recommended actions include funding agencies requiring all research proposals involving human participants to include a community engagement plan, providing adequate funding to support ongoing community engagement, including community stakeholders in agency governance and proposal reviews, promoting racial and ethnic diversity in the research workforce, and making a course in community engaged research a requirement for Masters of Clinical Research curricula.

BACKGROUND Community engagement can make a substantial difference in health outcomes and strengthen the capacity to deal with disruptive public health events such as the COVID-19 pandemic. Social media platforms such as Facebook are a promising avenue to reach the broader public and enhance access to clinical and translational science, and require further evaluation from the scientific community. OBJECTIVE This study aims to describe the use of live community events to enhance communication about clinical and health research through a Facebook platform case study (Minnesota [MN] Research Link) with a Minnesota statewide community. We examined variables associated with video engagement including video length and type of posting. METHODS From June 2019 to February 2021, MN Research Link streamed 38 live community events on its public Facebook page, MN Research Link. Live community events highlighted different investigators’ clinical and health research in the areas of mental health, health and wellness, chronic diseases, and immunology/infectious diseases. Facebook analytics were used to determine the number of views, total minutes viewed, engagement metrics, and audience retention. An engagement rate was calculated by the total number of interactions (likes, shares, and comments) divided by the total length of the live event by the type of live community event. RESULTS The 38 live community events averaged 23 minutes and 1 second in duration. The total time viewed for all 38 videos was 10 hours, 44 minutes, and 40 seconds. Viewers’ watch time averaged 23 seconds of content per video. After adjusting for video length, promotional videos and research presentations had the highest engagement and retention rates. Events that included audience participation did not have higher retention rates compared to events without audience participation. CONCLUSIONS The use of live community events showed adequate levels of engagement from participants. A view time of 23 seconds on average per video suggests that short informational videos engage viewers of clinical and translational science content. Live community events on Facebook can be an effective method of advancing health promotion and clinical and translational science content; however, certain types of events have more impact on engagement than others.

Background Community engagement can make a substantial difference in health outcomes and strengthen the capacity to deal with disruptive public health events such as the COVID-19 pandemic. Social media platforms such as Facebook are a promising avenue to reach the broader public and enhance access to clinical and translational science, and require further evaluation from the scientific community. Objective This study aims to describe the use of live community events to enhance communication about clinical and health research through a Facebook platform case study (Minnesota [MN] Research Link) with a Minnesota statewide community. We examined variables associated with video engagement including video length and type of posting. Methods From June 2019 to February 2021, MN Research Link streamed 38 live community events on its public Facebook page, MN Research Link. Live community events highlighted different investigators’ clinical and health research in the areas of mental health, health and wellness, chronic diseases, and immunology/infectious diseases. Facebook analytics were used to determine the number of views, total minutes viewed, engagement metrics, and audience retention. An engagement rate was calculated by the total number of interactions (likes, shares, and comments) divided by the total length of the live event by the type of live community event. Results The 38 live community events averaged 23 minutes and 1 second in duration. The total time viewed for all 38 videos was 10 hours, 44 minutes, and 40 seconds. Viewers’ watch time averaged 23 seconds of content per video. After adjusting for video length, promotional videos and research presentations had the highest engagement and retention rates. Events that included audience participation did not have higher retention rates compared to events without audience participation. Conclusions The use of live community events showed adequate levels of engagement from participants. A view time of 23 seconds on average per video suggests that short informational videos engage viewers of clinical and translational science content. Live community events on Facebook can be an effective method of advancing health promotion and clinical and translational science content; however, certain types of events have more impact on engagement than others.

Organized health promotion efforts sometimes compete with news media, social media, and other sources when providing recommendations for healthy behavior. In recent years, patients have faced a complicated information environment regarding aspirin use as a prevention tool for heart health. We explored the possibility that campaign promotion of low-dose aspirin use might have been undermined by news coverage in the USA detailing controversies regarding aspirin use. Using time series data on low-dose aspirin sales in Minnesota, USA, we assessed whether news coverage of aspirin or audience engagement with the Ask About Aspirin campaign website predicted subsequent changes in low-dose aspirin sales, over and above any secular trend. News coverage predicted actual low-dose aspirin purchases whereas exposure to a state-level campaign did not. While a campaign effort to encourage people at risk to discuss low-dose aspirin use with their health care providers did not generate substantive changes in low-dose aspirin tablet sales in the areas of Minnesota monitored for this study, past news coverage about aspirin use, including news about negative side effects, may have suppressed low-dose aspirin sales during this same period. The extent of news coverage about aspirin and heart health had a negative effect on tablet sales recorded in greater Minnesota approximately a month later in an ARIMA time series model, coefficient = −.014, t = −2.33, p = .02. Presented evidence of news coverage effect suggests health campaign assessment should consider trends in the public information environment as potential countervailing forces.

Introduction:Clinical and Translational Science Award Program (CTSA)-funded institutions were charged with developing clinical and translational science programs and transforming clinical research at their institutions. Community engagement (CE) was recognized as a key component and catalyst of that transformation. CE hub capacities for working with communities and translating knowledge into practice have been illustrated through their COVID-19 responses.Methods:CE hub leaders met and discussed their CTSA’s early responses regarding the COVID-19 pandemic. The 2-hour discussion was distilled into themes which were sent to the CE hub leaders with a request for written accounts describing actions taken to engage local partners, communities, and institutions. The written reports form the basis for this compendium.Results:Eighteen institutions submitted written reports describing activities in relation to six themes: (1) listen to the community and respond to concerns, (2) collect data to understand the impact of COVID-19 on distinct communities and groups, (3) communicate science and address misinformation, (4) collaborate with health departments, (5) engage hubs and underrepresented populations in COVID-19 research, and (6) support our own well-being and that of others.Conclusions:Bidirectional interactions comprise the foundation of CE, which requires trusted partnerships that sustain communication through a series of activities and goals. The nimble responses to the pandemic substantiate the need for CE programs to maintain the infrastructure necessary to achieve the primary CTSA goals of improving health within and across communities and localities as well as expanding research participation of community members.

Although previous work suggests that high performing practices focus on proactive patient outreach, the specific care management processes (CMP) that improve diabetes outcomes remain unclear. We evaluated 60 CMP from a state-wide practice survey in 2017 and 2019. Previously validated, the survey included 586 practices in 2017 (71% response, N=415) and 627 practices in 2019 (71% response, N= 445). Electronic health record data for A1c, blood pressure (BP), and lipid management were extracted for all patients with type 1 or type 2 diabetes in the practices. The longitudinal data set included 395 practices providing care to 204,745 patients. We used a longitudinal Bayesian model to correlate CMPs with A1c, systolic/diastolic BP, and probability of taking a statin. Patient outcomes were controlled for age, sex, diabetes type, insurance, comorbidity, community-level race-ethnicity, wealth, education, and income. Practices were controlled for rurality, size, FQHC status, system size, and practice-level random effects. Significance was reduced to Disclosure K. A. Peterson: Board Member; Self; Treatment.com International Inc. C. Carlin: None. L. Solberg: None. M. Eder: None. Funding National Institutes of Health (R18DK110732)

Stakeholder engagement is acknowledged as central to dissemination and implementation (D&I) of research that generates and answers new clinical and health service research questions. There is both benefit and risk in conducting stakeholder engagement. Done wrong, it can damage trust and adversely impact study results, outcomes, and reputations. Done correctly with sensitivity, inclusion, and respect, it can significantly facilitate improvements in research prioritization, communication, design, recruitment strategies, and ultimately provide results useful to improve population and individual health. There is a recognized science of stakeholder engagement, but a general lack of knowledge that matches its strategies and approaches to particular populations of interest based on history and characteristics. This article reviews stakeholder engagement, provides several examples of its application across the range of translational research, and recommends that Clinical Translational Science Awards, with their unique geographical, systems, and historical characteristics, actively participate in deepening our understanding of stakeholder engagement science and methods within implementation and dissemination research. These recommendations include (a) development of an inventory of successful stakeholder engagement strategies; (b) coordination and intentionally testing a variety of stakeholder engagement strategies; (c) tool kit development; and (d) identification of fundamental motivators and logic models for stakeholder engagement to help align stakeholders and researchers.

Introduction:Research opportunities associated with the proliferation of the electronic health record (EHR), big data initiatives, and innovative approaches to trial design can present challenges for obtaining and documenting informed consent. Broad-scale informed consent (a term used herein to describe institutional models, rather than the Common Rule’s strict regulatory definition for “broad consent”) may facilitate the use of existing data and samples and speed the pace of research by minimizing barriers to consent. We explored the use of broad-scale informed consent within the Clinical Translational Science Award (CTSA) Program Network.Methods:We surveyed CTSA Hubs concerning policies, practices, experiences, and needs within three domains of broad-scale informed consent: (1) participant recontact; (2) biospecimens; and (3) clinical data sharing.Results:Of 61 CTSA Hubs surveyed, 37 (61%) indicated ongoing work related to at least 1 domain of broad-scale informed consent; 18 Hubs (30%) reported work in all 3 domains. The EHR predominated as the implementation system across all three domains. Research and IT leadership and the Institutional Review Board were most commonly endorsed as institutional drivers, while systems/technical issues and impact on clinical workflow were the most commonly reported barriers.Conclusions:While survey results indicate considerable variability in the implementation of broad-scale informed consent across the CTSA consortium, it is clear that all CTSA Hubs are actively considering policy and process related to these concepts. Next steps cluster within three areas: training and workforce development, streamlined policies and templates, and implementation strategies that facilitate integration into clinical workflow.

Explorations of workflow development within primary care allow us to understand initial steps in the pace of knowledge and practice acclimatization within clinics. This study describes use of practice facilitation as an implementation strategy to communicate shared project goals and monitor and support refinement of practice behavior. This study engaged eight health care organizations, including 55 primary care practices, ≈380 clinicians, and ≈620 nursing and support staff in a guideline implementation project regarding United States Preventive Services Task Force use of aspirin recommendations for primary prevention of cardiovascular events.

This evaluation examined (a) the feasibility of recruiting 500 African American women and implementing a novel integration of Sisters Informing Sisters about Topics on AIDS (SISTA) and Safe...

Cardiovascular disease (CVD) disproportionately affects African Americans. Aspirin has long been recommended to reduce cardiovascular events. However, national guideline changes in 2016 limited the aspirin recommended population and several clinical trials questioning the utility of primary prevention aspirin were published in 2018. In light of the recent guidelines and study findings, we investigated primary prevention aspirin use among urban African American adults. Using three cross-sectional surveys, we collected data from self-identified African Americans with no CVD in 2015, 2017 and 2019, querying information on CVD risk factors, health behaviors and beliefs, and aspirin use. Poisson regression modeling was used to estimate age- and risk-factor adjusted aspirin prevalence, trends and associations. A total of 1491 African Americans adults, ages 45-79, were included in this analysis; 61% were women. There was no change in age- and risk factor-adjusted aspirin use over the 3 surveys for women (37%, 34% and 35% respectively) or men (27%, 25%, 30% respectively). However, fewer participants believed aspirin was helpful in 2019 compared to 2015-75% versus 84% (p 0.001). Aspirin discussions with a health care practitioner were highly associated with aspirin use (adjusted RR 2.97, 95% CI 2.49-3.54) and aspirin use was 2.56 times higher (adjusted RR 95% CI 2.17-3.03) in respondents who agreed that people close to them thought they should take aspirin compared with those who disagreed or did not know. Despite major changes in national guidelines, overall primary prevention aspirin use did not significantly change in these African American samples from 2015 to 2019.

Background USPSTF evidence-based recommendations for the use of low-dose aspirin for primary prevention of cardiovascular disease were published in 2009. We describe a statewide campaign using innovative methods to educate the public and health communities about appropriate aspirin use. Methods/design The “Ask About Aspirin” initiative is designed to lower the number of first heart attacks and strokes in the State of Minnesota by promoting the appropriate use of low dose aspirin. A health system intervention combined with an aspirin awareness media campaign will be evaluated in a pragmatic group randomized controlled trial including 267 primary care clinics within 84 health systems over a four year period. Matched pairs of geographic territories will be randomized to intervention (12 territories) or control (12 territories). The primary outcome of appropriate aspirin use will be measured at the individual level, by community-based telephone surveys of 100 participants in each of the 24 geographically determined clusters. Discussion We briefly describe the rationale for the interventions being studied, as well as the major design choices. Rigorous research designs such as the one described here are necessary to determine whether evidence-based recommendations can be effectively disseminated in multiple health systems. Trial registration ClinicalTrials.gov: NCT02607917 .

Given the complex health and social needs of older adults, the rapid growth of the aging population, and the increasing use of information technology in healthcare, there is a critical need for informatics solutions that advance gerontological nursing care and knowledge discovery. This article illustrates the value of standardized data for healthcare quality improvement throughout the life cycle of data capture and reuse. One such informatics solution is the MyStrengths+MyHealth app, which incorporates a whole-person perspective through the Simplified Omaha System Terms assessment, including the social and behavioral determinants of health, as well as resilience. The data describe whole-person health of older adults from MyStrengths+MyHealth for use in clinical encounters and as raw data for research. There is potential to use such standardized data to improve gerontological nursing care at the bedside and for population health management and research.

This trial tested a multicomponent intervention to increase colorectal cancer (CRC) screening among underserved patients. Participants were randomized to: (1) physician + patient intervention, (2) physician-only intervention, or (3) usual care (UC). Study outcomes included patient knowledge, physician recommendation of CRC screening, and screening completion via colonoscopy or stool tests. Among 538 participants, those exposed to the physician + patient intervention had significantly increased knowledge over patients in physician-only (p=.0008) or UC arms (p=.0003). However, there were no statistically significant differences in completion of CRC screening, with 10%, 20%, and 16% of UC, physician-only, and physician + patient participants screened, respectively. In UC, all completed screenings were colonoscopy, whereas in the physician-only and physician + patient arms, 39% and 46% of completed tests were via stool test, respectively. The multicomponent intervention did not increase overall CRC screening, yet results underscore the need to provide patients options for completing CRC screening.

Introduction: Community engagement is important for advancing Clinical and Translational Science (CTS), but face-to-face engagement has limited reach and scale. We examined the feasibility of a novel virtual Facebook community platform for public engagement on health research statewide in Minnesota. Methods: The Facebook platform, MN Research Link, was evaluated from June 19, 2019 to June 30, 2020. Facebook advertisements and boosts were used to recruit followers. Content, based on prior formative work, included health research information and interactive postings (e.g., live interviews with researchers). Standard metrics obtained from Facebook analytics included participation (followers), content reach (views), and engagement (likes, shares, comments, clicks). Results: During the 12-month period, we acquired 1406 followers (31% rural residents), with a retention of followers of 99.7%. Mean number of views per month was 9379.83 (Mdn = 2791, range 724–41,510). Engagement metrics indicated a mean of 535.2 likes, shares, comments, and/or clicks per month (Mdn = 296.5, range 55–1535). The page continued to acquire new followers, but a slight decrease in engagement was observed in the final months after state COVID-19 mitigation strategies were implemented. Conclusion: As the complexity of CTS continues to grow, along with social distancing measures resulting from the COVID-19 pandemic, the availability of virtual digital platforms to reach and engage community stakeholders in conversations about health and research has increasing importance. Preliminary findings from this program evaluation indicate that a Facebook community platform is feasible to engage Minnesota residents in conversations around health and research topics. Future work will evaluate its potential for reach, scale, and sustainability.

Introduction:Researchers have explored using the internet and social media to recruit participants to specific research projects. Less systematic work has been done to inform the engagement of large populations in virtual communities to advance clinical and translational science. We report on our first step to use social media to engage Minnesota residents by studying the willingness of participants to engage in a virtual (Facebook) community about the concepts of health and health-related research.Methods:Data were collected at the 2018 Minnesota State Fair using a cross-sectional, 46-item survey with assessment including sociodemographics and willingness to engage in a Facebook group for health-related research. Quantitative analysis included univariate, bivariate, and multivariate analyses. Content analysis was used to generate themes from open-ended survey responses.Results:Five hundred people completed the survey; after data cleaning, 418 participant responses informed this report. A majority were younger than age 50 (73%), female (66%), and married/partnered (54%). Overall, 46% of participants agreed/strongly agreed they are willing to join the Facebook group. Multivariate logistic regression identified social media use over the past 6 months as the sole variable independently associated with willingness to join the Facebook group (once a day vs. never or rarely OR = 1.82 (0.86, 3.88), several hours a day vs. never or rarely OR = 2.17 (1.17, 4.02, overall p-value 0.048).Conclusion:Facebook holds potential for reaching a broader community, democratizing access to and engagement with clinical and translational research. Social media infrastructure and content could be disseminated to other institutions with Clinical and Translational Science Awards.

Introduction: Cardiovascular disease (CVD) disproportionately affects African Americans. Aspirin has long been recommended as an option to reduce cardiovascular events. However, recent clinical trials involving primary prevention aspirin have prompted changes in national guidelines restricting the aspirin recommended population. Hypothesis: Primary prevention aspirin use will decline over the 5 year period 2015-2019. Methods: Using 3 cross-sectional surveys, data were collected from self-identified African Americans in 2015, 2017 and 2019, querying information on CVD risk factors, health behaviors and beliefs, and aspirin use. Poisson regression modeling was used to estimate age- and risk-factor adjusted aspirin prevalence, trends and associations. Results: A total of 1,491 African Americans adults, ages 45-79, 61% women and no prior CVD completed surveys and were included in this analysis. There was no change in age- and risk factor-adjusted aspirin use over the 3 surveys for women (37%, 34% and 35% respectively) or men (27%, 25%, 30% respectively). However, fewer participants believed aspirin was helpful in 2019--75% vs 84% in 2015 (p Conclusion: Despite major changes in national guidelines and negative perceptions of aspirin effectiveness in the media, overall primary prevention aspirin use did not significantly change in this African American sample from 2015 to 2019.

BackgroundRecruiting participants into clinical trials continues to be a challenge, which can result in study delay or termination. Recent studies have used social media to enhance recruitment outcomes. An assessment of the literature on the use of social media for this purpose is required.ObjectiveThis study aims to answer the following questions: (1) How is the use of social media, in combination with traditional approaches to enhance clinical trial recruitment and enrollment, represented in the literature? and (2) Do the data on recruitment and enrollment outcomes presented in the literature allow for comparison across studies?MethodsWe conducted a comprehensive literature search across 7 platforms to identify clinical trials that combined social media and traditional methods to recruit patients. Study and participant characteristics, recruitment methods, and recruitment outcomes were evaluated and compared.ResultsWe identified 2371 titles and abstracts through our systematic search. Of these, we assessed 95 full papers and determined that 33 studies met the inclusion criteria. A total of 17 studies reported enrollment outcomes, of which 9 achieved or exceeded their enrollment target. The proportion of participants enrolled from social media in these studies ranged from 0% to 49%. Across all 33 studies, the proportion of participants recruited and enrolled from social media varied greatly. A total of 9 studies reported higher enrollment rates from social media than any other methods, and 4 studies reported the lowest cost per enrolled participant from social media.ConclusionsWhile the assessment of the use of social media to improve clinical trial participation is hindered by reporting inconsistencies, preliminary data suggest that social media can increase participation and reduce per-participant cost. The adoption of consistent standards for reporting recruitment and enrollment outcomes is required to advance our understanding and use of social media to support clinical trial success.

Background Adolescent depression carries a high burden of disease worldwide, but access to care for this population is limited. Prevention is one solution to curtail the negative consequences of adolescent depression. Internet interventions to prevent adolescent depression can overcome barriers to access, but few studies examine long-term outcomes. Objective This study compares CATCH-IT (Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training), an internet-based intervention, to a general health education active control for depression onset at 12 and 24 months in adolescents presenting to primary care settings. Methods A 2-site randomized trial, blinded to the principal investigators and assessors, was conducted comparing Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training to health education to prevent depressive episodes in 369 adolescents (193 youths were randomly assigned to Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training and 176 to health education) with subthreshold depressive symptoms or prior depressive episodes. Participants were recruited from primary care settings in the United States. The primary outcome was the occurrence of a depressive episode, determined by the Depression Symptom Rating. The secondary outcome was functioning, measured by the Global Assessment Scale. Results In intention-to-treat analyses, the adjusted hazard ratio favoring Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training for first depressive episode was not statistically significant at 12 months (hazard ratio 0.77, 95% CI 0.42-1.40, P=.39) and 24 months (hazard ratio 0.87, 95% CI 0.52-1.47, P=.61). Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training provided preventive benefit for first depressive episode for those with mild hopelessness or at least moderate paternal monitoring at baseline. Global Assessment Scale scores improved comparably in both groups (intention-to-treat). Conclusions A technology-based intervention for adolescent depression prevention implemented in primary care did not have additional benefit at 12 or 24 months. Further research is necessary to determine whether internet interventions have long-term benefit. Trial Registration ClinicalTrials.gov NCT01893749; http://clinicaltrials.gov/ct2/show/NCT01893749.

BACKGROUND Recruiting participants into clinical trials continues to be a challenge, which can result in study delay or termination. Recent studies have used social media to enhance recruitment outcomes. An assessment of the literature on the use of social media for this purpose is required. OBJECTIVE This study aims to answer the following questions: (1) How is the use of social media, in combination with traditional approaches to enhance clinical trial recruitment and enrollment, represented in the literature? and (2) Do the data on recruitment and enrollment outcomes presented in the literature allow for comparison across studies? METHODS We conducted a comprehensive literature search across 7 platforms to identify clinical trials that combined social media and traditional methods to recruit patients. Study and participant characteristics, recruitment methods, and recruitment outcomes were evaluated and compared. RESULTS We identified 2371 titles and abstracts through our systematic search. Of these, we assessed 95 full papers and determined that 33 studies met the inclusion criteria. A total of 17 studies reported enrollment outcomes, of which 9 achieved or exceeded their enrollment target. The proportion of participants enrolled from social media in these studies ranged from 0% to 49%. Across all 33 studies, the proportion of participants recruited and enrolled from social media varied greatly. A total of 9 studies reported higher enrollment rates from social media than any other methods, and 4 studies reported the lowest cost per enrolled participant from social media. CONCLUSIONS While the assessment of the use of social media to improve clinical trial participation is hindered by reporting inconsistencies, preliminary data suggest that social media can increase participation and reduce per-participant cost. The adoption of consistent standards for reporting recruitment and enrollment outcomes is required to advance our understanding and use of social media to support clinical trial success.

Background: Diabetes care quality has changed little over the past 12 years. To learn what strategies and factors seem most important for improvement, we conducted a mixed method analysis of clinic interviews and characteristics of clinics that are in the high, middle, and low quartiles on a composite measure for diabetes. Method: We interviewed 31 leaders from 17 primary care clinics selected from the 416 that agreed to participate in a larger observational study of diabetes performance improvement. Semi-structured interviews on barriers and facilitators of diabetes care were recorded, transcribed, and analyzed for both comparison among clinics at different levels of performance on the outcome measure. We combined interview data with quantitative data about clinic performance on a standardized composite measure of diabetes outcomes and a survey of the presence of care management processes. Results: Interview analysis identified 10 themes that provided unique insights into the factors and strategies that were associated with differences in performance level. The main difference among them was the degree to which top performing clinics used patient data to guide proactive and outreach methods to intensify treatment and monitor impact. Top clinics also reported fewer barriers and more facilitators than lower ranked ones, while all recognized key help from the larger organizations of which most were a part. Conclusions: Top performing clinics’ approach to diabetes care differs from lower performing clinics focusing on proactive care occurring outside of the traditional practice setting. Although confirmatory studies are needed for these preliminary findings, clinical leaders might benefit by considering the value of replicating these differences. Disclosure L. Solberg: None. K.A. Peterson: None. H.N. Fu: None. M. Eder: None. R. Jacobsen: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R18DK110732)

Highlights • Patients face a complex health information environment including advertisements and news. • Campaign advertising and news exposure predicted patient web tool use and online searches. • ARIMA (AutoRegressive Integrated Moving Average) time series model predicted behavior., Objective Using indicators of campaign effort and relevant news stories, we sought to predict two patterns of patient behavior regarding information about aspirin and heart health: patient use of a campaign web tool to determine whether they should talk with a physician about using aspirin and patient searches for information about aspirin and the heart. Methods We used ARIMA modeling to predict two time series as a function of independent variables. Results We found significant prediction of time series in both models, but campaign expenditure only predicted use of a campaign web tool whereas weekly news stories predicted online searches regarding aspirin and the heart originating from Minnesota. Conclusion Patient information engagement is a function of information salience at least in part. Campaign advertising expenditure can prompt audience use of campaign tools but news coverage also operates as an important force on patient search behavior. Practice Implications Health promotion professionals charged with reaching patients with heart health and stroke prevention messages should monitor news coverage as a potential complementary or rival force while at the same time promoting campaign-related information online.

Community-based participatory research (CBPR) partnerships exist as complex, dynamic relationships that incorporate shared decision that supports trust development between communities and academics. Within CBPR, the interest in understanding the concept of trust has grown with the realization that, without trust, CBPR relationships fracture. A barrier to monitoring the trust health of a partnership is the lack of a shared operationalization of the concept, its antecedents, and measurement tools. To address these barriers, a six-category trust typology was created as a developmental theory of trust progress. To advance the theory, this article reports on the quantitative structural elements of the trust typology, identifies variability in trust correlates, and creates an empirical foundation for the trust types. Using Engage for Equity data, trust covariates included measures of synergy, CBPR principles, participation, and influence. Structural equation models were used to assess associations between trust types and the latent constructs measured by the items in each measure. The findings demonstrate that the six trust types generally operate on a continuum. Specifically, it does appear that trust deficit, role-based trust, functional trust, proxy trust, and reflective trust are on a single continuum from low to high. Scale scores for reflective trust and proxy trust were consistently and statistically significantly higher than those for functional trust, role-based, neutral, and trust deficit. These results support the construct validity of the trust typology as representing “higher levels” of trust phases. Due to the dynamic nature of partnerships, regular monitoring of partnership trust types can serve as a proxy for partnership functioning.

Background: Cardiovascular disease (CVD) and CVD risk factors are high among people of color. Aspirin (ASA) can reduce CVD risk. Yet little is known about primary prevention ASA use and its determinants among people of color. This study examined associations for ASA-related health beliefs and social norms, CVD risk factors and ASA use among Hispanic/Latino (HL) and African American (AA) adults without CVD history. Methods: In-person surveys were administered to adults ages 45-79 years at health fairs and community events in the Minneapolis-St. Paul metro querying demographics, CVD history, CVD risk factors and ASA use. CVD risk perceptions and ASA-related health beliefs and social norms were evaluated using a 4-point Likert scale. Poisson regression with adjustment for age, sex and risk factors was used to examine associations with ASA use. Surveys were offered in English or Spanish. Results: Of the 583 survey participants with no CVD history, 152 identified as HL and 431 as Non-Hispanic-AA. Compared with AA, the HL sample was younger, mean (SD) age of 53.0 (8.6) years vs 59.3 (9.3) years; 54.6% vs 65.7% were female. Risk factors were common among HL and AA, including diabetes (37.5% and 29.0%), hyperlipidemia (28.3% and 36.7%), hypertension (36.8% and 61.0%) and smoking (13.8% and 21.1%). Twenty-two percent of HL and 34% of AA participants regularly used ASA. When asked questions regarding health beliefs and social norms, HL adults had a high frequency of “Don’t Know” responses compared with AA’s (Figure). Participants with more “Don’t Know” responses were less likely to use ASA—RR of 0.87 (95% CI 0.77-0.99). Conversely, ASA use was positively associated with “Agree” responses (RR 1.40, 95% CI 1.29-1.52) and CVD risk factors (RR 1.43 95% CI 1.28-1.59). Associations did not differ by race/ethnicity (interaction p >0.05). Conclusion: ASA uncertainty is more pronounced among HL adults than AA and is associated with less preventive ASA use. Efforts should be made to improve knowledge regarding the appropriate use of ASA in this population.

Collaboration between academic researchers and community members, clinicians, and organizations is valued at all levels of the program development process in community-engaged health research (CEnR). This descriptive study examined a convenience sample of 30 projects addressing training in CEnR methods and strategies within the Clinical and Translational Science Awards (CTSA) consortium. Projects were selected from among posters presented at an annual community engagement conference over a 3-year period. Study goals were to learn more about how community participation in the design process affected selection of training topics, how distinct community settings influenced the selection of training formats, and the role of evaluation in preparing training participants to pursue future health research programming. Results indicated (1) a modest increase in training topics that reflected community health priorities as a result of community (as well as academic) participation at the program design stage, (2) a wide range of community-based settings for CEnR training programs, and (3) the majority of respondents conducted evaluations, which led in turn to revisions in the curricula for future training sessions. Practice and research implications are that the collaboration displayed by academic community teams around CEnR training should be traced to see if this participatory practice transfers to the design of health promotion programs. Second, collaborative training design tenets, community formats and settings, and evaluation strategies should be disseminated throughout the CTSA network and beyond. Third, common evaluative metrics and indicators of success for CEnR training programs should be identified across CTSA institutions.

BackgroundThe Clinical and Translational Science Award (CTSA) institutions are increasing development of training programs in community-engaged research (CEnR) to support translational science.MethodsThis study sampled posters at CTSA national meetings to identify CEnR training approaches, topics, and outcomes.ResultsQualitative analysis of 30 posters revealed training topics and outcomes focused primarily on CEnR capacity building, overcoming barriers, systems change, and sustainability.ConclusionFurther research should focus on development and results of CTSA CEnR training program metrics.

Background The institutions that comprise the Clinical and Translational Science Award (CTSA) consortium and the National Center for Advancing Translational Sciences continue to explore and develop community-engaged research strategies and to study the role of community academic partnerships in advancing the science of community engagement. Objectives To explore CTSA institutions in relation to an Institute of Medicine recommendation that community engagement occur in all stages of translational research and be defined and evaluated consistently. Methods A sequential multimethods study starting with an online pilot survey followed by survey respondents and site informant interviews. A revised survey was sent to the community engagement and evaluation leads at each CTSA institution, requesting a single institutional response about the definitions, indicators, and metrics of community engagement and community-engaged research. Results A plurality of CTSA institutions selected the definition of community engagement from the Principles of Community Engagement. Although claiming unique institutional priorities create barriers to developing shared metrics, responses indicate an overall lack of attention to the development and deployment of metrics to assess community engagement in and contributions to research. Conclusions Although definitions of community engagement differ among CTSAs, there seem to be more similarities than differences in the indicators and measures tracked and reported on across all definitions, perhaps owing to commonalities among program infrastructures and goals. Metrics will likely need to be specific to translational research stages. The assessment of community engagement within translational science will require increased institutional commitment.

Objetivo. Evaluar el efecto del extracto acuoso de Tropaeolum tuberosum “mashua” sobre el deterioro de la memoria y la lipoperoxidacion inducida por fluoxetina en higado en Rattus rattus var. albinus ooferectomizadas. Materiales y Metodos . Estudio experimental. Se usaron 29 animales de experimentacion intervenidos por seis semanas divididos en cinco grupos: Blanco (n=5), que no recibio ninguna intervencion; Control (n=6), ratas con ooforectomia bilateral; Patron (n=6), ratas ooforectomizadas a las cuales se les administro 20 mg/kg por via oral de una solucion de 0,15 % de fluoxetina (inductor de lipoperoxidacion) por tres semanas, una vez al dia; y finalmente los grupos Problema I (n=6) y II (n=6) que recibieron la misma intervencion del grupo Patron por tres semanas y, posteriormente, se les administro el extracto de Tropaeolum tuberosum “mashua” a una dosis de 1 g/kg en concentraciones de 10 y 20%. Resultados. Se encontro diferencias significativas en el grupo que recibio el extracto de Tropaeolum tuberosum al 10% en comparacion con el que recibio solo fluoxetina (p=0,002). No se encontraron diferencias significativas entre grupos ni intra grupo en la evaluacion sobre el deterioro de la memoria. Conclusion. El extracto acuoso al 10% de Tropaeolum tuberosum en dosis de 1g/kg mostro una disminucion en la peroxidacion lipidica inducida por Fluoxetina en Rattus rattus var. albinus ooferectomizadas.

Background and Purpose: Depression affects millions of adolescents in the United States each year. This population may benefit from targeted preventive interventions. We sought to understand the internal factors that affect the ability of healthcare organizations to implement an intervention that involves mental health screening and depression prevention treatment of at-risk adolescents in primary care settings. Methods: From November 2011 to July 2016 we conducted a study of the implementation of a multisite (N=30) phase 3 randomized clinical trial of an Internet-based depression prevention intervention program (CATCH-IT). We describe the prevalence of internal barriers on the screening and enrollment process by reporting REACH (the proportion of target audience exposed to the intervention). Results: A total of 369 adolescents were randomized into the intervention or control program. Mean REACH values for the study clinics were 0.216 for screening and 0.181 for enrollment to CATCH-IT. Mean REACH enrollment lost due to internal barriers was 0.233. This translated to 4,691 adolescents lost at screening and 2,443 adolescents lost at enrollment due to internal barriers. Conclusion: We propose a model of the implementation process that emphasizes the importance of positive relational work that assists in overcoming internal barriers to REACH. We also provide implications for policy and practice.