Paper Session 18: Dissemination and Implementation

Background: Latina immigrants in rural settings face significant barriers to accessing mental health care, exacerbating mental health disparities. Many rural areas throughout the United States lack trained bilingual mental health professionals. Community health workers are increasingly being used to provide culturally relevant care in areas with a limited workforce. This study tested the feasibility of a using a community health worker (CHW) implementation strategy to deliver Amigas Latinas Motivando el Alma (ALMA), a community-based mental health intervention for Latina immigrants.

Methods: We conducted a pilot study in central Washington, training five CHWs to deliver the ALMA intervention at two community-based organizations. The intervention consisted of six weekly sessions incorporating mindfulness, stress reduction, and community-building activities. CHWs then offered the program to Latina immigrants each of their organizations (n=27). We collected survey data on participant demographics, intervention fidelity, participant attendance, satisfaction, and changes in depression (PHQ-8) and anxiety (GAD-7) pre- and post-intervention.

Results: We found high participant engagement, with most participants attending an average of 70% of the sessions. Overall, the CHWs successfully delivered the intervention with fidelity, although time constraints and competing obligations occasionally led to skipped components. Participants reported high satisfaction with the program (mean score 4.5 out of 5), and reported learning strategies to improve self-esteem, self-compassion, and self-care. Mean depression scores (PHQ-8) decreased from 7.2 (mild severity) pre-intervention to 4.5 (minimal severity) post-intervention, and anxiety scores (GAD-7) decreased from 6.7 (mild severity) to 3.8 (minimal severity).

Discussion: These results indicate that using the CHW implementation strategy to deliver ALMA is feasible in rural settings. Our findings highlight the potential role of CHWs in addressing mental health disparities among Latina immigrants. Future research should evaluate this approach in a larger trial with a more rigorous study design.

Author - Juan Gudino, MPH,
University of Washington

Co-Author - S. Adriana Pérez-Solorio, MPH,
University of Washington

Co-Author - Barbara Baquero, PhD, MPH,
University of Washington

Co-Author - Deepa Rao, PhD,
Univ. of Washington/Harborview Med. Ctr.

Chair - India J. Ornelas, PhD, MPH,
University of Washington

Introduction: Healthy checkout policies that set nutritional standards for store checkout areas were recently implemented in two U.S. cities and have been recommended for consideration by federal policymakers. We examined which of four message frames garnered the highest public support for this policy type.

Methods: A sample of U.S. adults (n=3,978) matching national distributions of key sociodemographic characteristics participated in an online experiment. Participants were randomized to one of four messages describing a hypothetical healthy checkout policy framed as: (1) expanding healthy choices, (2) making shopping less stressful for parents by removing junk food from children’s eye-level, (3) improving community and child health, or (4) addressing predatory marketing. The primary outcome was support for a healthy checkout policy. Data were analyzed using a generalized linear model with a Poisson distribution and robust standard errors. We then explored how support for a healthy checkout policy varied by sociodemographic variables.

Results: Most participants (65%) supported a healthy checkout policy. Support was highest when framed around “making shopping less stressful for parents” (68%), followed by “improving community and child health” (67%), “addressing predatory marketing” (64%), and “expanding healthy choices” (61%). Support for a healthy checkout policy was significantly higher when framed as “making shopping less stressful for parents by removing junk food from children’s eye-level” than “addressing predatory marketing” and “expanding healthy choices” (p-values<0.05). Support for a healthy checkout policy was also significantly higher when framed as “improving community and child health” than “expanding healthy choices” (p<0.01). There was no significant effect modification by sociodemographic variables; however, Hispanic adults and adults in the Northeast were significantly more likely to support a healthy checkout policy (p-values<0.05), regardless of frame.

Conclusion: Support for a healthy checkout policy was high, especially in response to message framing around making shopping less stressful for parents or improving community and child health . Hispanic communities and those in the Northeast may especially support healthy checkout policies.

Author - Andrea M. Gil, BS,
University of California, Davis

Co-Author - Alexandria E. Reimold, PhD,
University of California, Davis

Co-Author - Brittany Lemmon, MS,
University of California, Davis

Co-Author - Ethan C. Wolf, MPH,
University of California, Davis

Co-Author - Lori Dorfman, DrPH,
Berkeley Media Studies Group

Co-Author - Susan D. Brown, PhD, FSBM,
University of California, Davis

Co-Author - Lauren E. Au, PhD, RD,
University of California, Davis

Co-Author - Jennifer Falbe, ScD, MPH,
University of California, Davis

Background: Continuous glucose monitoring (CGM) technology has enabled closed loop (CL) systems which partially automate insulin delivery to regulate glucose levels for people with type 1 diabetes (T1D). CL systems require adoption and sustained use of CGM. Given previously documented rates of CGM discontinuation among adults with T1D, the goal of this qualitative study was to elicit narratives of successful CL adoption from adults with T1D who progressed from prior CGM discontinuation to CL adoption within a 12-month period.

Methods: Adults (18+ years old) with T1D who had participated in a larger CGM uptake study were invited to take part in a qualitative study to understand experiences of successful CL system adoption within 12 months of CGM initiation following prior CGM discontinuation. Interviews and focus groups were audio-recorded, transcribed, and analyzed using thematic analysis.

Results: Participants were 16 adults with T1D (age 33.4±6.3 years; diabetes duration 20.9±12.0 years; 81.3% female; 62.5% White, 25.0% Asian, 6.3% Hispanic, 6.3% Black). Participants described how they were able to overcome barriers to CL adoption and the benefits they experienced as a result. Barriers included: 1) prior CGM discontinuation due to inaccuracy and usability issues; 2) distrust of technology due to prior negative experiences; and 3) cost and insurance barriers. Participants reported wanting to adopt CL to prevent hypoglycemia and increase time in glucose target range and experienced these benefits and decreased mental burden following adoption. In describing adjusting to CL use, many experienced challenges with giving over diabetes management control to a CL algorithm. Some participants appreciated receiving ongoing support for CL onboarding (e.g., from their endocrinology care team, device representatives, and T1D community), while others only received initial training. These participants said they would have wanted access to continuing device support throughout the first 3-4 months of CL adoption to optimize use and reduce distress.

Conclusions: CL systems have become the new standard of care for T1D management but barriers remain to adopting these advanced systems. Understanding how participants overcame challenges to adopt CL provides useful direction for enhancing and standardizing CL onboarding education across systems, and for developing resources to reduce barriers to adopting CL systems so more people living with T1D can benefit.

Presenter - Mabelle Pasmooij, BS,
Stanford University School of Medicine

Co-Author - Dessi Zaharieva, CEP CDCES,
Stanford University School of Medicine

Co-Author - Molly L. Tanenbaum, PhD,
Stanford University School of Medicine

As research needs become increasingly complex and team science practices grow in acceptance, the average number of authors has increased from 1.9 in 1975, to 5.67 in 2016. These larger author teams require skills in communication and collaboration. Relatedly, the National Association of Colleges and Employers (NACE; 2022) lists communication, critical thinking, and teamwork as core competencies for career readiness. Student involvement in research has notable benefits for their subsequent academic and professional careers. Furthermore, publishing with students also benefits faculty mentors, yet faculty face competing demands on their time.

We use Paper Chase as a team science model to engage interdisciplinary learners in research. This writing method challenges a team of trainees to use faculty research findings to collaborate synchronously over a short period (e.g., 24 hours over multiple work days) to develop a scientific manuscript for submission to a peer-reviewed outlet. Using this writing approach as a foundation, our team developed a campus-wide professional development program to train students and faculty in academic writing and collaborative research dissemination.

We evaluated the impacts across two years of campus-wide Paper Chase programming (2021 virtual, 2022 in-person). Data was collected one to two years following participation. Two trained research assistants unaffiliated with the Paper Chase program conducted semi-structured interviews with a sample of past student and faculty participants. Four researchers analyzed the 21 interviews using thematic analyses. Participants described immediate impacts: training/structure of Paper Chase, mentorship, and scientific integration. Intermediate impacts included teamwork, attitudes toward teamwork, writing skills, and publications. Longer-term impacts were career influences (e.g., applying to graduate school). These findings suggest that the Paper Chase program fosters favorable changes in attitudes and skills among participants. Involvement in research dissemination was instrumental in demystifying research and researchers among undergraduate students. The program facilitates new ways of communicating, teamwork, mentorship, and self-efficacy and can be replicated at other institutions. Longer-term evaluations may be needed to understand further impacts, such as changes in faculty’s team science, mentorship approaches, or publication records.

Presenter - Jessamyn Moxie, PhD,
UNC Charlotte

Co-Presenter - Alicia A. Dahl, PhD, PhD,
University of North Carolina at Charlotte

Co-Author - J. Kevin Benson,
UNC Charlotte