The role of funded partnerships in working towards decreasing COVID-19 vaccination disparities, United States, March 2021-December 2022.

During the COVID-19 vaccination rollout from March 2021- December 2022, the Centers for Disease Control and Prevention funded 110 primary and 1051 subrecipient partners at the national, state, local, and community-based level to improve COVID-19 vaccination access, confidence, demand, delivery, and equity in the United States. The partners implemented evidence-based strategies among racial and ethnic minority populations, rural populations, older adults, people with disabilities, people with chronic illness, people experiencing homelessness, and other groups disproportionately impacted by COVID-19. CDC also expanded existing partnerships with healthcare professional societies and other core public health partners, as well as developed innovative partnerships with organizations new to vaccination, including museums and libraries. Partners brought COVID-19 vaccine education into farm fields, local fairs, churches, community centers, barber and beauty shops, and, when possible, partnered with local healthcare providers to administer COVID-19 vaccines. Inclusive, hyper-localized outreach through partnerships with community-based organizations, faith-based organizations, vaccination providers, and local health departments was critical to increasing COVID-19 vaccine access and building a broad network of trusted messengers that promoted vaccine confidence. Data from monthly and quarterly REDCap reports and monthly partner calls showed that through these partnerships, more than 295,000 community-level spokespersons were trained as trusted messengers and more than 2.1 million COVID-19 vaccinations were administered at new or existing vaccination sites. More than 535,035 healthcare personnel were reached through outreach strategies. Quality improvement interventions were implemented in healthcare systems, long-term care settings, and community health centers resulting in changes to the clinical workflow to incorporate COVID-19 vaccine assessments, recommendations, and administration or referrals into routine office visits. Funded partners' activities improved COVID-19 vaccine access and addressed community concerns among racial and ethnic minority groups, as well as among people with barriers to vaccination due to chronic illness or disability, older age, lower income, or other factors.

Medical education for African American communities in the rural South: A focus group approach to identify fundamental considerations.

PURPOSE: We sought to understand concerns fundamental to planning medical education specific to rural southern African Americans who are virtually nonexistent in American medical schools. METHODS: A diverse multidisciplinary research team conducted this qualitative study with 3 focus groups, including 17 rural medical educators recruited nationwide, 10 African American alumni of a rural medical education pipeline in Alabama, and 5 community and institutional associates of this pipeline. Analysis of recorded transcripts generated themes fitting an ecological model suggesting concerns and intervention foci at individual, community, and institutional levels. FINDINGS: Three major themes operating at all ecological levels were: (1) How "rural minority student" is defined, with "rural" often supplanting race to indicate minority status; (2) Multiple factors relate to rural racial minority student recruitment and success, including personal relationships with peers, mentors, and role models and supportive institutional policies and culturally competent faculty; and (3) Challenges to recruitment and retention of rural minority students, especially financial concerns and preparation for medical education. CONCLUSIONS: Our findings suggest that individuals, communities, and institutions provide intervention points for planning medical education specific to southern rural African Americans. These spheres of influence project a need for partnership among communities and rural medical educators to affect broad programmatic and policy changes that address the dire shortage of rural African American health professionals to help ameliorate health inequities experienced in their home communities. It is likely that linear thinking and programming will be replaced by integrated, intertwined conceptualizations to reach this goal.

Increasing Uptake of Prescription Drug Take-Back Boxes: Eliciting Preferences and Applying the Theory of Planned Behavior to Predict Use.

This study assesses adults' perceptions of and predictors of intention to use prescription drug take-back boxes. This mixed methods study utilized focus groups and an online survey to examine factors related to intention to use a prescription drug take-back box. This study was conducted in [State] during the spring and summer of 2018. Themes identified in focus group data included the importance of take-back box location, benefits of take-back box use (such as reducing opportunities for medication misuse), and barriers to take-back box use (such as lack of awareness, stigma associated with law enforcement). Survey results indicate that pharmacies are the most preferred take-back box location and that attitudes, subjective norms, and perceived behavioral control are statistically significant predictors of intention to use a take-back box. Results suggest that individuals are open to using take-back boxes in secure, convenient locations, but many are unaware of take-back boxes as an option for safe disposal. These findings have implications for health communication and policy efforts designed to increase the use of take-back boxes for prescription drug disposal.

Rural adults' perceived role of family members in prescription opioid misuse prevention: Implications for family-based approaches.

PURPOSE: This study explored and documented rural adults' perceptions of family roles in prescription opioid misuse prevention and the predisposing, reinforcing, and enabling factors that influence family members from taking those roles. METHODS: Nine focus groups with rural adults (n = 55) were conducted to evoke discussion about family roles in prescription opioid misuse prevention. Transcripts were coded based on common ideas that arose during the focus groups, previous literature, and the PRECEDE-PROCEED program planning model. FINDINGS: Findings suggest that rural adults perceive the opioid epidemic as partially a family problem. Additionally, rural adults perceive themselves as having a critical role in preventing prescription opioid misuse among family members. Participants identified specific predisposing, reinforcing, and enabling factors that influence whether or not family members take responsibility in preventing prescription opioid misuse within their families. Rural adults also perceive that family-based education is important in preventing prescription opioid misuse. CONCLUSIONS: These results suggest that there is an interest in family-based approaches that enable or foster the skills and resources necessary to engage in prescription opioid misuse prevention behaviors. Specifically, family-based prevention programming should include efforts to shape knowledge and attitudes about prescription opioid misuse, increase resources to facilitate prevention behaviors, and build skills related to prevention.

4-H Healthy Living programs with impact: a national environmental scan.

The 4-H youth development program of the nation's 109 land-grant universities and the Cooperative Extension System is one of the largest youth development organization in the United States serving approximately six million youth. The 4-H Healthy Living initiative began in 2008 to promote achievement of optimal physical, social, and emotional well-being for youth and families. In 2013, the National 4-H Council sought to identify 4-H Healthy Living programs in the domains of healthy eating and physical activity that adhered to the national 4-H Healthy Living mission and were ready for comprehensive outcome evaluation or replication at a national level. This chapter shares findings from an environmental scan of 4-H programs and (a) identifies programs with evidence of promoting a healthy diet and physical activity, (b) describes program impacts related to healthy diet and physical activity, and (c) clarifies select program characteristics associated with reported healthy eating and/or physical activity outcomes. The RE-AIM evaluation framework is introduced as an effective approach to assessing program impact for 4-H Healthy Living and similar out-of-school time programs.

Farmers' concerns: a qualitative assessment to plan rural medical education.

CONTEXT: Limited research suggests that translational approaches are needed to decrease the distance, physical and cultural, between farmers and health care. PURPOSE: This study seeks to identify special concerns of farmers in Alabama and explore the need for a medical education program tailored to prepare physicians to address those concerns. METHODS: We conducted 2 focus groups with 20 farmers from diverse communities, backgrounds, and farming operations. The sessions were audio-recorded, transcribed, coded, and analyzed for determined patterns. FINDINGS: The following categories were developed as areas of importance to farmers: the need for physicians to understand the culture of farming, occupational exposures in farming, and recommendations for improving the health of farmers. CONCLUSION: Findings suggest that to adequately serve farmers, medical students interested in entering practice in rural areas should have or develop a relevant and adequate understanding of farming practices.

Undergraduate rural medical education program development: focus group consultation with the NRHA Rural Medical Educators Group.

CONTEXT: Over a decade ago, leaders in rural medical education established the Rural Medical Educators (RME) Group, an interest group within the National Rural Health Association, to support faculty in rural medical education programs. This group has convened an annual RME conclave since 2006. In 2008, this conclave convened 15 national leaders in rural medical education at The University of Alabama. METHODS: In preparation for the conclave, potential participants were e-mailed a set of questions regarding their respective medical education program's initiating motivation, support, resistance, resources, accomplishments, and continuation plans. Analysis of participants' responses resulted in a question guide that was used at a focus group conducted at the conclave. PURPOSE: The purpose of the focus group was to explore the experiences of established rural medical educators related to program development and maintenance. The focus group was recorded and transcribed, and then analyzed using the constant comparative method. FINDINGS: Five essential elements for rural medical education programs emerged from the analysis. The elements were: admit the right student, include curricular elements that occur and are required in rural training sites, establish a cadre of rural physicians who are dedicated to education of their successors, secure financial and relational support for the program, and evaluate program progress. DISCUSSION AND CONCLUSIONS: Discussion about these 5 elements can provide program guidance to neophyte rural medical education programs. Five recommendations are presented in an effort to continue discussion about the essential elements and identify actions that rural medical educators can take to further assist developing programs.

Getting on Target with Community Health Advisors (GOTCHA): an innovative stroke prevention project.

Health disparities along with insufficient numbers of healthcare providers and resources have created a need for effective and efficient grassroots approaches to improve community health. Community-based participatory research (CBPR), more specifically the utilization of community health advisors (CHAs), is one such strategy. The Getting on Target with Community Health Advisors (GOTCHA) project convened an interdisciplinary team to answer the call from 10 counties in the rural Mississippi Delta area of 'The Stroke Belt' to meet the region's identified health needs, and to impact the health of a disparaged state. This article explores this CBPR project including the community involvement strategies, innovative CHA training curriculum, evaluation plan, and implications to healthcare professionals, particularly nurses.

Capacity building for health through community-based participatory nutrition intervention research in rural communities.

Since its inception, capacity building has been a stated goal of the Delta Nutrition Intervention Research Initiative, a tri-state collaboration in the Lower Mississippi Delta to address high rates of chronic disease. Textual analysis of project documents identifies and describes strategies carried out to foster capacity building. Strategies to build community capacity include fostering participation, cultivating leadership opportunities, training community members as co-researchers, securing community resources, and implementing the intervention together. Incorporating capacity-building approaches in health promotion and nutrition-intervention programming in rural communities provides a means to enhance potential for sustainability of health outcomes and developed effectiveness.

Dialogue to deliberation: expanding the empowerment education model.

OBJECTIVE: To explore the importance of a theoretical framework, the Empowerment education model (EEM), that can be used in participatory research. A deliberative project in one community in eastern Kentucky exemplifies the use of the EEM in participatory research. METHODS: Research techniques include surveys, focus groups, community forums, and photovoice. RESULTS: This project presents preliminary evidence that participatory projects might benefit if the dialogue phase of the EEM is followed by a deliberative phase. CONCLUSION: The theoretical underpinnings of the EEM could be expanded to include dialogue and deliberation in participatory efforts.

The use of photovoice as a method of facilitating deliberation.

Efforts have been made in one rural Appalachian county to broaden local participation in a community health assessment. Through a series of community forums and a photovoice project, residents named community health needs and assets, framed potential solutions, and selected possible action steps to improve the local health status. Photographs and narratives from the photovoice project supplemented information from preliminary health forums to devise a framework of possible solutions to the identified health problems. Analysis of forum transcripts suggests that participants who used an issue guide that used photovoice images and stories were able to transition from broad approaches of change to specific action steps more than participants in other forums who used a more traditional forum issue guide. Community members are more easily able to identify solutions to local health issues when forum discussions are informed by local images and narratives.