Identifying Barriers to Effective Patient-Provider Communication About Food Insecurity Screenings in Outpatient Clinical Settings in Central Florida: A Mixed-Methods Study.

OBJECTIVE: Screening for food insecurity in health care settings is inconsistently performed among health care providers. This study examined how patient-provider interactions influenced patient comfort discussing food insecurity, an important social determinant of health. DESIGN: We conducted a convergent mixed-methods study and surveyed patients on their experiences with patient-centered care when communicating and interacting with their providers, and their comfort level being screened for food insecurity. Telephone interviews were also conducted to better understand the concepts in the survey. SETTING: Various clinical organizations in Central Florida, as well as food pantries affiliated with Second Harvest Food Bank. PARTICIPANTS: Forty-six patients in Central Florida completed the survey, 12 of whom completed qualitative portions of the study (7 completing the qualitative survey questions and 5 completing a telephone interview). MAIN OUTCOME MEASURE: Patient comfort discussing food insecurity with their health care providers. RESULTS: Quantitative findings show that patient involvement in care planning and cultural sensitivity of health care providers were 2 important factors associated with patient comfort being screened for food insecurity. Qualitative findings suggest that providers' effective communication and empathy are other factors that can influence patient comfort. CONCLUSION: To effectively address food insecurity of vulnerable patients and communities, it is important that providers conduct screenings within their practice. This study points to specific actions that providers may employ to increase patient comfort discussing this topic. Efficiently identifying food-insecure patients and connecting them to appropriate community resources would improve patient health and aid in efforts to eliminate health disparities.

Promising Aging in Community Models in the U.S.: Village, Naturally Occurring Retirement Community (NORC), Cohousing, and University-Based Retirement Community (UBRC).

Aging in Community (AIC) is the preferred way to age. This systematic review identified promising AIC models in the U.S. and analyzed model characteristics and push-pull factors from older adults' perspectives. Push factors are those driving older adults to leave, while pull factors attract them to stay in a community. We conducted a two-phase search strategy using eight databases. Phase I identified promising AIC models and Phase II expanded each specific model identified. Fifty-two of 244 screened articles met the criteria and were analyzed. We identified four promising AIC models with the potential to achieve person-environment (P-E) fit, including village, naturally occurring retirement community (NORC), cohousing, and university-based retirement community (UBRC). Each has a unique way of helping older adults with their aging needs. Similar and unique push-pull factors of each AIC model were discussed. Analyses showed that pull factors were mostly program factors while push factors were often individual circumstances. Continued research is needed to address the challenges of recruiting minority older adults and those of lower socio-economic status, meeting older adults' diverse and dynamic needs, and conducting comparative studies to share lessons learned across the globe.

Doctor-Patient Cancer Screening Communications among Church-based Chinese Adults - The Role of Caregiver Experience and Family History.

OBJECTIVE: Significant gap exists in the literature examining cancer screening communication related factors among Chinese immigrants.  This study examined the role of cancer caregiver experience and family history on doctor-patient cancer screening communication among church-based Chinese adults. METHODS: A self-administered survey was conducted among adults from 9 Chinese churches (n=372). Cancer Communication was measured by "Dr. recommended screenings" and "Talked to doctors about cancer screenings". The survey was developed in English and translated in Chinese. RESULTS: Mean age was 44.31 (SD=14.74), 60% were males, 72% were married, majority had college education (85%), and 17% reported had been a primary cancer caregiver and 54% reported having family cancer history. Cancer caregivers scored higher on doctor-patient cancer communication, as well as cancer knowledge and screening norms.  Participants with family cancer history were also more likely to talk to doctor about screening, as well as perceived higher cancer risk, lower health status, and screening barriers. Multiple regression analyses showed that primary caregiver experience was still a significant predictor on talking to doctors about cancer screenings (OR=2.1; 95%CI=[1.10, 4.01]; p=0.025), yet doctors more like to recommend screening among caregivers became non-significant.  The significant influence of family cancer history on talking with doctors on cancer screenings also disappeared.  Older age (OR=2.52; p=0.006) and being married (OR=2.45; p=0.022) were significant on predicting communication of cancer screenings with doctors. Data also showed that doctors were more likely to recommend cancer screenings to older (OR=2.75, p <.001), married (OR=2.57; p=0.006) adults. CONCLUSION: Current study calls attentions to primary cancer caregiver experience, family history, age, and marital factors when designing tailored doctor-patient cancer screening communication programs among church-based Chinese to address cancer disparities.

Remain Independence and Neighborhood Social Cohesiveness Among Older Adults Participating in Three Community-Based Programs Promoting Aging-in-Community in the USA.

Objectives: Aging-in-community has been a preferred way to aging. This study examines and compares remain independence (RI) and neighborhood social cohesiveness (NSC) among three programs promoting aging-in-community (AIC). Methods: Older adults from three AIC programs were surveyed: a village program, a county neighborhood lunch program, and a university-based lifelong learning program. Previously validated RI (3-item) and NSC (4-items) measures were used. Results: Mean age was 72.4 (SD = 8.68) years (n = 289). Both the RI and NSC scales showed satisfactory reliabilities, with Cronbach's alphas of .81 and .88, respectively. Analyses showed significant inter-group differences on both RI and NSC. After controlling for demographics, regressions showed inter-group differences remained for RI, while disappeared for NSC. Education level had an inverse relationship with RI, whereas married status had a positive relationship with NSC scores. Discussion: Findings call attentions to RI among higher education and NSC among single older adults for community-based services and programs promoting aging-in-community.

A Cross-sectional Study of Cancer Knowledge and Beliefs Among Faith-based Chinese in the USA Versus Taiwan.

OBJECTIVES: This study examined cancer knowledge, beliefs, and practice among faith-based Chinese in the USA versus Taiwan to gain better understandings on how environment and culture might play a role for tailored cancer education programs. METHODS: A self-administered survey included a validated 10-item Cancer Screening Belief Scale (CSBS), an 8-item Cancer Screening Knowledge Test (CSKT), and a 14-item cancer Warning Signs Test (CWST) was administered. Participants were recruited from 9 Chinese churches (5 in the USA and 4 in Taiwan). RESULTS: A total of 372 Chinese participated, 50% lived in the USA and 50% in Taiwan. Mean age was 44.31 (standard deviation, 14.74), 60% males, and majority had college education (85%). Taiwan participants scored higher on both CSKT (6.13 vs. 5.52; p<0.001) and CWST (6.80 vs. 5.38; p<0.001). Although perceived screening benefits and barriers were similar, Taiwan participants endorsed higher on screening norms (11.67 vs. 10.82; p<0.001). Taiwan participants also indicated more doctor recommending cancer screenings (42.1% vs. 29.6%; p=0.015), USA participants were more likely to have had annual health exams (65.4% vs. 48.9%; p=0.002). Regression results showed that those resided in the USA were 2.38 times more likely to report annual health exams. Married status (odds ratio [OR], 2.85), college education (OR, 2.38), doctor's recommendation (OR, 2.87), no family cancer history (OR, 2.47), and those with lower barriers were significant factors on annual health exams. CONCLUSIONS: Taiwan participants scored higher on cancer knowledge and screening norms, while more USA participants reported annual health exams. Taiwan's universal healthcare might play a role on the different healthcare seeking patterns.

Mixed methods in public health research in Taiwan - Using visual diagrams to communicate complex design procedures.

Scholars introduce modern mixed methods research (MMR) and its application in public health research in Taiwan. Specifically, they showcase a multi-phased Taiwan cervical cancer screening mixed methods study using visual diagrams to communicate complex design procedures. While some previous researchers have incorporated quantitative and qualitative data in research, here we hope to provide significant clarity to guide those new to the MMR field. We have structured the article in the following way. First, we provide a brief overview of MMR. Second, we illustrate the compelling need for MMR from a public health perspective using cancer screenings as an example. Third, we introduce the Taiwan cervical cancer screening program as an exemplar of MMR application and the utility of visual diagrams. Study methodology can be applied to international researchers and scholars from interdisciplinary fields beyond public health.

A Systematic Review of Promising Strategies of Faith-Based Cancer Education and Lifestyle Interventions Among Racial/Ethnic Minority Groups.

Church-based interventions have been used to reach racial/ethnic minorities. In order to develop effective programs, we conducted a comprehensive systematic review of faith-based cancer prevention studies (2005~2016) to examine characteristics and promising strategies. Combination terms "church or faith-based or religion," "intervention or program," and "cancer education or lifestyle" were used in searching the five major databases: CINAHL; ERIC; Health Technology Assessments; MEDLINE; and PsycInfo. A total of 20 studies met study criteria. CDC's Community Guide was used to analyze and review group interventions. Analyses were organized by two racial groups: African American (AA) and Latino/Hispanic American groups. Results showed most studies reviewed focused on breast cancer alone or in combination with other cancers. Studies of Latino/Hispanic groups targeted more on uninsured, Medicare, or Medicaid individuals, whereas AA studies generally did not include specific insurance criteria. The sample sizes of the AA studies were generally larger. The majority of these studies reviewed used pre-post, posttest only with control group, or quasi-experience designs. The Health Belief Model was the most commonly used theory in both groups. Community-based participatory research and empowerment/ecological frameworks were also used frequently in the Latino/Hispanic studies. Small media and group education were the top two most popular intervention strategies in both groups. Although one-on-one strategy was used in some Latino studies, neither group used reducing client out-of-pocket costs strategy. Client reminders could also be used more in both groups as well. Current review showed church-based cancer education programs were effective in changing knowledge, but not always screening utilization. Results show faith-based cancer educational interventions are promising. To maximize intervention impact, future studies might consider using stronger study designs, incorporating a variety of proven effective strategies, including those frequently used evidence-based strategies, as well as exploring promising strategies among specific target groups.

Health for Older Adults: The Role of Social Capital and Leisure-Time Physical Activity by Living Arrangements.

BACKGROUND: The purposes of this study were to (1) explore the influence of social capital and leisure-time physical activity on older adults' physical and mental health and (2) test whether these relationships varied by living arrangement. METHODS: This cross-sectional study used national data from the 2013 National Health Interview Study. The subjects included 7714 adults aged 65 years or older. Logistic regressions were used to predict the probability of subjects being overweight or obese. Ordinary linear regressions were performed to predict mental health outcomes. RESULTS: Older adults living alone were more likely to report feeling sad (alone: 1.5; with others: 1.36), hopeless (alone: 1.25; with others: 1.18), and worthless (alone: 1.22; with others: 1.15). They were also more likely to experience lower levels of social support (alone: 3.24; with others: 3.30), trust (alone: 3.34; with others: 3.44), cohesion (alone: 2.95; with others: 2.98), and enjoy less leisure-time physical activity (alone: 49.85 min; with others: 64.64 min) than those living with others. Hispanic and divorced/separated older adults who lived alone were prioritized for health intervention. CONCLUSIONS: Older adults living alone had poorer mental health, less social capital, and engaged in less frequent leisure-time physical activity. Promoting social capital could improve mental health in older adults living alone.

Subjective and Objective Cancer Screening Knowledge Among White- and Blue-Collar Chinese Midlife Adults.

Cancer is the leading cause of death among Chinese, yet little is known about cancer knowledge among this population. The study described the subjective and objective cancer screening knowledge among white- versus blue-collar Chinese midlife adults. A convenient sample of white-collar adults age 40+ years was recruited from government and academic agencies; and blue-collar adults age 40+ years were recruited from manufactory companies in Taiwan. An eight-item cancer screening knowledge test (CSKT) was used to measure objective knowledge and one five-point Likert scale item for assessing subjective (perceived) cancer screening knowledge. A total of 208 white- and 533 blue-collar workers completed the survey during 2008-2011. Mean ages between groups were comparable (41.1 versus 46.3 years), as well as family cancer history (41.5 %). About 76 % of the white-collar and 43 % of the blue-collar adults had college education. The mean score of the CSKT was lower in the blue-collar versus white-collar workers, 5.4 (SD = 1.76) versus 6.1 (SD = 1.40), indicating on average, 68 versus 76 % of the participants answered the cancer knowledge correctly. The subjective knowledge levels were, however, higher among the blue-collar workers (mean rating of 3.22 versus 2.78). The CSKT showed a good mix of relatively easy and moderately difficult items in both groups. Study showed that overall cancer screening knowledge was low among Chinese midlife adults. Although blue-collar workers scored lower on CSKT, the perceived knowledge level was higher. Results also suggest attention to communicating cancer screening information among Chinese blue-collar midlife workers in particular.

Objective and Subjective Cancer Knowledge Among Faith-Based Chinese Adults.

This study examined cancer knowledge between church-going younger versus older Chinese adults. Hou's 8-item validated cancer screening knowledge test (CSKT) and a new 14-item cancer warning signs test (CWST) were used to assess objective knowledge. Subjective knowledge was measured by one overall 5-point Likert scale item. A total of 372 Taiwanese and Chinese Americans from nine churches participated. Although there were no significant differences by age on either the CSKT scores (younger = 5.89 vs. older = 5.71; p = .297) or the CWST (younger = 6.27 vs. older = 5.86; p = .245), subjective knowledge was higher among older Chinese adults (younger = 2.44 vs. older = 3.05, p < .001). Older Chinese adults were also more likely to identify cancer warning signs correctly, while younger adults were more likely to identify false warning signs correctly. Results have implication on tailoring cancer knowledge type (subjective vs. objective) and content domain (screening vs. warning signs). Findings can help health educators better understand cancer education needs among Chinese adults.

A systematic review on US-based community health navigator (CHN) interventions for cancer screening promotion--comparing community- versus clinic-based navigator models.

This study synthesized lessons learned from US-based community and clinic health navigator (CHN) interventions on cancer screening promotion to identify characteristics of models and approaches for addressing cancer disparities. The combination terms "cancer screening" and "community health workers or navigators" or "patient navigators" were used in searching Medline, CINAHL, and PsycInfo. A total of 27 articles published during January 2005∼April 2014 were included. Two CHN models were identified: community-based (15 studies) and clinic/hospital-based (12 studies). While both models used the term "navigators," most community-based programs referred them as community health workers/navigators/advisors, whereas clinic-based programs often called them patient navigators. Most community-based CHN interventions targeted specific racial/ethnic minority or rural groups, while clinic-based programs mostly targeted urban low income or mixed ethnic groups. Most community-based CHN programs outreached members from community networks, while clinic-based programs commonly worked with pre-identified in-service clients. Overall, regardless model type, CHNs had similar roles and responsibilities, and interventions demonstrated effective outcomes. Our review identified characteristics of CHN interventions with attention to different settings. Lessons learned have implication on the dissemination and implementation of CHN interventions for cancer screening promotion across setting and target groups.

Systematic literature review of Internet interventions across health behaviors.

Purpose: This review examines Internet interventions aiming to change health behaviors in the general population. Methods: Internet health interventions in the USA published between January 2005 and December 2013 were identified through Medline and CINAHL. Keywords used were (Internet or e-health or social media or web) paired with (intervention or program*). A total of 38 articles met all criteria and were reviewed. Results: Studies were analyzed by targeted health behavior interventions: tobacco (5), alcohol (4), weight loss (7), physical activity (PA) (7), nutrition (2), PA and nutrition combined (5), HIV or sexual health (4), and chronic diseases (4). Interventions ranged from one session to 24  weeks (average 6-12 weeks). Common strategies used, including web-based information, tailored feedback, weekly e-mails, goal setting, and self-assessment. Social cognitive theory and the transtheoretical models were the most commonly used frameworks. Recruitment strategies were typically media based varied by settings and populations. Except for the tobacco interventions, the majority studies yielded significant outcomes. Conclusion: This review provides updates and synthesized knowledge on the design and consistent effectiveness of Internet interventions across health behaviors. Results have implications for public health and healthcare professionals, as they play a key role in developing and delivering health promotion interventions as well as in assisting the communities and clients serviced obtaining evidence-based health information.

"A Breast Ain't Nothing but a Sandwich": narratives of Ella, an African American social worker breast cancer survivor.

Breast cancer mortality rates continue to increase among African American women making it imperative to develop culturally tailored programs to help reduce these rates. In this study, narratives of Ella an African American breast cancer survivor who is also a social worker were constructed. Prevalent themes were self-identity, perceptions of women living with cancer, and the socialization of African Americans in cancer prevention. Her perspective as a survivor and social worker offers insight on how the intersection of race and gender impacts breast cancer survival and has implications for future research in cancer awareness among African Americans.

Health Literacy Online: A Guide to Writing and Designing Easy-to-Use Health Web Sites.

Health Literacy Online: A Guide to Writing and Designing Easy-to-Use Health Web Sites is a practical and well-written resource for public health and health communication professionals and web designers. This guide builds on the principles of web usability and adds to existing best practices by providing research-based strategies for writing and designing health websites especially for users with limited literacy and health literacy skills. This guide synthesizes years of lessons learned from Office of Disease Prevention and Health Promotion's original research with hundreds of web users, experience with revising the healthfinder.gov, as well as strategies supported by the Research-Based Web Design and Usability Guidelines (Usability.gov). In the United States, roughly one third of adults have limited literacy skills, yet far more (as many as 90%) have limited health literacy skills, meaning they have trouble understanding complex health information. This how-to guide is timely and developed with the aim of creating easy-to-use health websites to reach as many web users as possible, especially those with limited literacy and health literacy skills.

HIV/AIDS complacency and HIV infection among young men who have sex with men, and the race-specific influence of underlying HAART beliefs.

BACKGROUND: Among men who have sex with men (MSM) in the United States, the influence of HIV/AIDS complacency and beliefs about the efficacy of highly active antiretroviral therapy (HAART) on HIV-infection risk is unknown. METHODS: We analyzed data from a 1998-2000 cross-sectional 6-city survey of 1575 MSM aged 23 to 29 years who had never tested for HIV or had last tested HIV-negative to assess these plausible influences overall and by race/ethnicity. FINDINGS: Measured as strong endorsement for reduced HIV/AIDS concern due to HAART, HIV/AIDS complacency was associated with reporting ≥10 male sex partners (odds ratio [OR], 2.94; 95% confidence interval [CI], 2.12-4.07), unprotected anal intercourse with an HIV-positive or HIV-unknown-status male partner (OR, 2.06; 95% CI, 1.51-2.81), and testing HIV-positive (adjusted OR [AOR], 2.35; 95% CI, 1.38-3.98). Strong endorsement of the belief that HAART mitigates HIV/AIDS severity was more prevalent among black (21.8%) and Hispanic (21.3%) than white (9.6%) MSM (P < 0.001), and was more strongly associated with testing HIV-positive among black (AOR, 4.65; 95% CI, 1.97-10.99) and Hispanic (AOR, 4.12; 95% CI, 1.58-10.70) than white (AOR, 1.62; 95% CI, 0.64-4.11) MSM. CONCLUSIONS: Young MSM who are complacent about HIV/AIDS because of HAART may be more likely to engage in risk behavior and acquire HIV. Programs that target HIV/AIDS complacency as a means to reduce HIV incidence among young MSM should consider that both the prevalence of strong HAART-efficacy beliefs and the effects of these beliefs on HIV-infection risk might differ considerably by race/ethnicity.

A plausible causal model of HAART-efficacy beliefs, HIV/AIDS complacency, and HIV-acquisition risk behavior among young men who have sex with men.

Despite considerable research, the causal relationship remains unclear between HIV/AIDS complacency, measured as reduced HIV/AIDS concern because of highly active antiretroviral therapy (HAART), and HIV risk behavior. Understanding the directionality and underpinnings of this relationship is critical for programs that target HIV/AIDS complacency as a means to reduce HIV incidence among men who have sex with men (MSM). This report uses structural equation modeling to evaluate a theory-based, HIV/AIDS complacency model on 1,593 MSM who participated in a venue-based, cross-sectional survey in six U.S. cities, 1998-2000. Demonstrating adequate fit and stability across geographic samples, the model explained 15.0% of the variance in HIV-acquisition behavior among young MSM. Analyses that evaluated alternative models and models stratified by perceived risk for HIV infection suggest that HIV/AIDS complacency increases acquisition behavior by mediating the effects of two underlying HAART-efficacy beliefs. New research is needed to assess model effects on current acquisition risk behavior, and thus help inform prevention programs designed to reduce HIV/AIDS complacency and HIV incidence among young MSM.

Closing the disparity gap: cancer screening interventions among Asians--a systematic literature review.

BACKGROUND: Cancer is a leading cause of deaths among Asian Americans. However, the rates of screening among Asian Americans are low. The use of effective culturally-appropriate interventions needs to be explored. METHODS: Electronic databases were searched for articles published between January 1995 and December 2010 for a comprehensive literature review. Interventions to increase breast, cervical and colorectal cancer screening among Asians populations in the US and overseas were included. RESULTS: A total of thirty studies were reviewed. These studies differed on study design, target population, theoretical underpinning of intervention approach and outcome measures. Effective interventions employed a variety of strategies including the use of social networks, lay health workers, media education, community-based education, reminder notices, health care provider assistance and health system changes. Fifteen studies utilized behavioral theories in intervention development. CONCLUSIONS: This review finds culturally-appropriate community-based interventions and lay health worker strategies can improve cancer screening behaviors among Asian populations. Selections of intervention strategies will depend on the characteristics of the target group and feasibility of implementation. Challenges and recommendations for tailored screening interventions for Asians are discussed.

Reasons for not HIV testing, testing intentions, and potential use of an over-the-counter rapid HIV test in an internet sample of men who have sex with men who have never tested for HIV.

BACKGROUND: Correlates of main reasons for not HIV testing, HIV testing intentions, and potential use of an over-the-counter rapid HIV test (OTCRT) among men who have sex with men who have never tested for HIV (NTMSM) are unknown. METHODS: We evaluated these correlates among 946 NTMSM from 6 US cities who participated in an internet-based survey in 2007. FINDINGS: Main reasons for not testing were low perceived risk (32.2%), structural barriers (25.1%), and fear of testing positive (18.1%). Low perceived risk was associated with having fewer unprotected anal intercourse (UAI) partners and less frequent use of the internet for HIV information; structural barriers were associated with younger age and more UAI partners; fear of testing positive was associated with black and Hispanic race/ethnicity, more UAI partners, and more frequent use of the internet for HIV information. Strong testing intentions were held by 25.9% of all NTMSM and 14.8% of those who did not test because of low perceived risk. Among NTMSM who were somewhat unlikely, somewhat likely, and very likely to test for HIV, 47.4%, 76.5%, and 85.6% would likely use an OTCRT if it was available, respectively. CONCLUSIONS: Among NTMSM who use the internet, main reasons for not testing for HIV vary considerably by age, race/ethnicity, UAI, and use of the internet for HIV information. To facilitate HIV testing of NTMSM, programs should expand interventions and services tailored to address this variation. If approved, OTCRT might be used by many NTMSM who might not otherwise test for HIV.

Time will tell: community acceptability of HIV vaccine research before and after the "Step Study" vaccine discontinuation.

OBJECTIVE: This study examines whether men-who-have-sex-with-men (MSM) and transgender (TG) persons' attitudes, beliefs, and risk perceptions toward human immunodeficiency virus (HIV) vaccine research have been altered as a result of the negative findings from a phase 2B HIV vaccine study. DESIGN: We conducted a cross-sectional survey among MSM and TG persons (N = 176) recruited from community settings in Atlanta from 2007 to 2008. The first group was recruited during an active phase 2B HIV vaccine trial in which a candidate vaccine was being evaluated (the "Step Study"), and the second group was recruited after product futility was widely reported in the media. METHODS: Descriptive statistics, t tests, and chi-square tests were conducted to ascertain differences between the groups, and ordinal logistic regressions examined the influences of the above-mentioned factors on a critical outcome, future HIV vaccine study participation. The ordinal regression outcomes evaluated the influences on disinclination, neutrality, and inclination to study participation. RESULTS: Behavioral outcomes such as future recruitment, event attendance, study promotion, and community mobilization did not reveal any differences in participants' intentions between the groups. However, we observed greater interest in HIV vaccine study screening (t = 1.07, P < 0.05) and enrollment (t = 1.15, P < 0.05) following negative vaccine findings. Means on perceptions, attitudes, and beliefs did not differ between the groups. Before this development, only beliefs exhibited a strong relationship on the enrollment intention (ß = 2.166, P = 0.002). However, the effect disappeared following negative trial results, with the positive assessment of the study-site perceptions being the only significant contributing factor on enrollment intentions (ß = 1.369, P = 0.011). CONCLUSION: Findings show greater enrollment intention among this population in the wake of negative efficacy findings from the Step Study. The resolve of this community to find an HIV vaccine is evident. Moreover, any exposure to information disseminated in the public arena did not appear to negatively influence the potential for future participation in HIV vaccine studies among this population. The results suggest that subsequent studies testing candidate vaccines could be conducted in this population.

The likelihood of participation in clinical trials can be measured: the Clinical Research Involvement Scales.

OBJECTIVE: We developed the Clinical Research Involvement Scales (CRIS) to assess the willingness to participate in a clinical trial. STUDY DESIGN AND SETTING: Diverse populations (N=919) aged 18 years or older from Atlanta, Georgia, were included in comprehensive testing of the 41-item CRIS instrument. The formative phase focused on item content for the new measures (n=54). Questionnaires from potential vaccine trial participants (n=865), collected at multiple time points, resulted in the evaluation of scale reliability and validity (i.e., attitudes, behavioral and normative beliefs, perceived social support for clinical research participation, social norm compliance, perceptions of the clinical research organization, and perceived relevance of the research endeavor). RESULTS: Qualitative testing revealed adequate comprehension and content validity of the initial item set. The subjective norms domain (n=3) initially exhibited poor internal consistency in pilot testing (Cronbach's alpha=0.525); yet, rewording of the items resulted in consistently stable measurement improvement (Cronbach's alpha=0.850). Each of the CRIS subscales demonstrated extremely high reliability, ranging from 0.734 to 0.918. Confirmatory factor analysis verified item-factor relationships and determined construct and convergent validity (root mean square error of approximation=0.068; comparative fit index=0.835). CONCLUSIONS: CRIS is a reliable instrument for measuring community attitudes toward participation in biomedical research studies. Results of this study support the use of these scales to recruit diverse populations to clinical trials.